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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.

Author information

1
Department of Pediatric Surgery, Arkansas Children's Hospital, Little Rock, AR. Electronic address: lgurien@gmail.com.
2
Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN.
3
Department of Pediatric Surgery, Children's Hospital of Alabama, Birmingham, AL.
4
Department of Pediatric Surgery, Medical University of South Carolina, Charleston, SC.
5
Department of Pediatric Surgery, Washington University School of Medicine, St. Louis, MO.
6
Department of Pediatric Surgery, Albany Medical Center, Albany, NY.
7
Department of Pediatric Surgery, University of Tennessee Health Science Center, Memphis, TN.
8
Department of Pediatric Surgery, Arkansas Children's Hospital, Little Rock, AR.

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 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.

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.

PMID:
27460931
DOI:
10.1016/j.surg.2016.05.019
[Indexed for MEDLINE]

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