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Surgery. 2016 Dec;160(6):1605-1611. doi: 10.1016/j.surg.2016.05.019. Epub 2016 Jul 25.

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

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Department of Pediatric Surgery, Arkansas Children's Hospital, Little Rock, AR. Electronic address:
Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN.
Department of Pediatric Surgery, Children's Hospital of Alabama, Birmingham, AL.
Department of Pediatric Surgery, Medical University of South Carolina, Charleston, SC.
Department of Pediatric Surgery, Washington University School of Medicine, St. Louis, MO.
Department of Pediatric Surgery, Albany Medical Center, Albany, NY.
Department of Pediatric Surgery, University of Tennessee Health Science Center, Memphis, TN.
Department of Pediatric Surgery, Arkansas Children's Hospital, Little Rock, AR.



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.


Using data gathered from 14 institutions, we performed a retrospective cohort study of patients <18 years old who underwent central venous catheter placement. Patient demographics and operative details were collected. We used a logistic regression model to evaluate factors associated with real-time ultrasonography use.


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.


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.

[Indexed for MEDLINE]

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