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Complications and risks of central venous catheter placement in children
E M Johnson1, D A Saltzman, G Suh
1University of Minnesota, Department of Surgery, Minneapolis 55455, USA.
Insights
Central venous catheterization in children is safe, with a 3.2% complication rate. Key risks include multiple attempts, failed placement, and malposition, emphasizing the need for careful technique in pediatric central venous access.
Area of Science:
- Pediatric Medicine
- Vascular Access Procedures
- Medical Device Safety
Background:
- Central venous catheters (CVCs) are widely used in pediatrics for long-term access.
- Despite benefits, CVC placement carries risks of morbidity and mortality.
- Placement is often performed by trainees, highlighting the need to understand associated risks.
Purpose of the Study:
- To identify and analyze risks and complications associated with CVC placement in children.
- To determine independent risk factors for complications in pediatric CVC procedures.
- To evaluate the overall safety of CVC insertion in a pediatric population.
Main Methods:
- Retrospective review of 1435 pediatric CVC procedures over 10 years.
- Data collection included patient demographics, procedural details, and complications.
- Logistic regression analysis was used to identify independent risk factors for complications.
Main Results:
- A total of 3.1% perioperative complications were observed.
- Independent risk factors for complications included multiple attempts (OR=5.4), failed attempts (OR=5.2), and catheter misplacement (OR=6.9).
- Subclavian vein catheterization was associated with fewer complications compared to other sites.
Conclusions:
- Pediatric central venous catheterization demonstrates a low complication rate (3.2%) and no mortality in this series.
- Procedural factors like multiple attempts, failed attempts, and catheter misplacement significantly increase complication risk.
- The findings support the relative safety of CVCs in children when performed with attention to technique.
Background:
Since Aubaniac's first description in 1952, the use of central venous catheters has increased dramatically; they are now considered commonplace. Placement of these catheters, however, has an associated risk of morbidity and mortality. In most cases, this risk is outweighted by the benefit gained, especially when long-term access to the central venous system is needed for multiple transfusions, chemotherapy, antibiotics, or parenteral nutrition. A large number of central venous catheters are placed in children at our institution, usually by interns and residents.
Methods:
To identify associated risks and complications, we reviewed the records of 1435 consecutive catheterizations in children over a 10-year period. Data collected included age, sex, site of catheterization, type of catheter, primary disease, prior catheterizations, indication for placement, failed attempts, number of attempts, catheter misplacement, level of physician training, new needle punctures, and complications. We then used logistic regression analysis to identify independent risk factors for complications.
Results:
We noted 39 (3.1%) perioperative complications, including 19 (1.5%) arterial punctures, 10 (0.8%) pneumothoraces, 6 (0.5%) hemothoraces, 2 (0.2%) cases of superior vena cava syndrome, 1 (0.1%) episode of ventricular fibrillation that required cardioversion, and 1 episode of bleeding that required a cutaneous suture. Univariate analysis revealed that catheters placed in a subclavian vein (vs all other sites combined, P < .01) were less likely to have an associated complication. In addition, multiple attempts (vs success on first attempt, P < .0001), failed attempt (vs success at initial site, P < .0001), catheter misplacement (vs proper initial position, P < .01), and prior catheterizations (vs no prior catheterization, P < .0005) were associated with complications. Logistic regression revealed multiple attempts (vs success on first attempt, odds ratio (OR) = 5.4), failed attempt (vs success at initial site, OR = 5.2), and catheter misplacement (vs proper initial position, OR = 6.9) to be independent risk factors for complications. Age, sex, type of catheter, primary disease, indication for placement, and level of physician training (intern or resident vs staff) were not associated with complications.
Conclusions:
Central venous catheterization in children is relatively safe, with only a 3.2% complication rate and no mortality in our series.