Real-time ultrasonography for placement of central venous catheters in children: A multi-institutional study.

Creator(s)

Lori A. Gurien
Martin L. Blakely
Robert T. Russell
Christian J. Streck
Adam M. Vogel
Elizabeth J. Renaud
Kate B. Savoie
Melvin S. Dassinger
Pediatric Surgery Research (PedSRC) Collaborative
Shawn D. St Peter, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

12-1-2016

Identifier

DOI: 10.1016/j.surg.2016.05.019

Abstract

BACKGROUND: Recommendations for the use of real-time ultrasonography for placement of central venous catheters in children are based on studies involving adults treated by nonsurgeons. Our purpose was to determine the frequency of use of real-time ultrasonography use by pediatric surgeons during central venous catheter placement, patient and procedure factors associated with real-time ultrasonography use, and adverse event rates.

METHODS: Using data gathered from 14 institutions, we performed a retrospective cohort study of patientsuse.

RESULTS: Real-time ultrasonography was used in 33% of attempts (N = 1,146). The subclavian vein (64%) was accessed preferentially for first site insertion. Real-time ultrasonography was less likely to be used for subclavian vein (odds ratio = 0.002; P < .0001) and more likely to be used when coagulopathy (international normalized ratio >1.5) was present (odds ratio = 11.1; P = .03). The rate of mechanical complications was 3.5%. Real-time ultrasonography use was associated with greater procedural success rates on first-site attempt, but also with a greater risk of hemothorax.

CONCLUSION: Pediatric surgeons access preferentially the subclavian vein for central venous access, yet are less likely to use real-time ultrasonography at this site. Real-time ultrasonography was superior to the landmark techniques for the first-site procedure success, yet was associated with greater rates of hemothorax. Prospective trials involving children treated by pediatric surgeons are needed to generate more definitive data.

Journal Title

Surgery

Volume

160

Issue

6

First Page

1605

Last Page

1611

MeSH Keywords

Age Factors; Catheterization, Central Venous; Child; Child, Preschool; Female; Humans; Infant; Male; Patient Selection; Practice Patterns, Physicians'; Retrospective Studies; Subclavian Vein; Ultrasonography, Interventional

Keywords

Ultrasound; Central Lines

Recommended Citation

Gurien LA, Blakely ML, Russell RT, et al. Real-time ultrasonography for placement of central venous catheters in children: A multi-institutional study. Surgery. 2016;160(6):1605-1611. doi:10.1016/j.surg.2016.05.019