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Intensive Care Med. 2018 Jan;44(1):61-72. doi: 10.1007/s00134-017-4985-8. Epub 2017 Dec 1.

Ultrasound-guided or landmark techniques for central venous catheter placement in critically ill children.

Author information

1
Paediatric Intensive Care Unit, Complejo Asistencial Universitario de León, Altos de Nava s/n, 24008, León, Spain. ignacio.oulego@gmail.com.
2
Paediatric Intensive Care Unit, Hospital Materno-Infantil Universitario Gregorio Marañón, Calle de O'Donnell, 48, 28009, Madrid, Spain.
3
Paediatric Intensive Care Unit, Hospital Universitario Carlos Haya de Málaga, Av. de Carlos Haya, s/n, 29011, Málaga, Spain.
4
Paediatric Intensive Care Unit, Hospital Sant Joan de Dèu, Passeig Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Spain.
5
Paediatric Intensive Care Unit, Hospital Reina Sofía de Córdoba, Av. Menéndez Pidal, s/n, 14004, Córdoba, Spain.
6
Paediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Av. De Roma, s/n, 33011, Oviedo, Asturias, Spain.
7
Paediatric Intensive Care Unit, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain.
8
Paediatric Intensive Care Unit, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Av. de Barber, 30, 45004, Toledo, Spain.
9
Paediatric Intensive Care Unit, Hospital de La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain.
10
Paediatric Intensive Care Unit, Hospital Universitario Ramón y Cajal. Ctra, Colmenar Viejo, km. 9,100, 28034, Madrid, Spain.
11
Paediatric Intensive Care Unit, Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009, Saragossa, Spain.
12
Paediatric Intensive Care Unit, Hospital Universitario Son Espases, Carr. de Valldemossa, 79, 07120, Palma, Islas Baleares, Spain.
13
Paediatric Intensive Care Unit, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain.
14
Paediatric Intensive Care Unit, Parc Taulí Hospital Universitari, Parc Taulí, 1, 08208, Sabadell, Barcelona, Spain.
15
Paediatric Intensive Care Unit, Hospital Universitario de Salamanca, Paseo de San Vicente, 88-182, 37007, Salamanca, Spain.
16
Paediatric and Emergency Care Department, Complejo Hospitalario Universitario de Santiago de Compostela, Travesía de Choupana, s/n, 15706, Santiago de Compostela, Spain.

Abstract

PURPOSE:

To assess whether ultrasound guidance improves central venous catheter placement outcomes compared to the landmark technique in critically ill children.

METHODS:

A prospective multicentre observational study was carried out in 26 paediatric intensive care units over 6 months. Children 0-18 years old who received a temporary central venous catheter, inserted using either ultrasound or landmark techniques, were eligible. The primary outcome was the first-attempt success rate. Secondary outcomes included overall placement success, number of puncture attempts, number of procedures requiring multiple punctures (> 3 punctures), number of procedures requiring punctures at more than one vein site and immediate mechanical complications. To account for potential confounding factors, we used propensity scores. Our primary analysis was based on 1:1 propensity score matching. The association between cannulation technique and outcomes in the matched cohort was estimated using generalized estimating equations and mixed-effects models to account for patient-level and hospital-level confounders.

RESULTS:

Five hundred central venous catheter-placement procedures involving 354 patients were included. Ultrasound was used for 323 procedures, and the landmark technique was used for 177. Two hundred and sixty-six procedures were matched (133 in the ultrasound group and 133 in the landmark group). Ultrasound was associated with an increase in the first-attempt success rate [46.6 vs. 30%, odds ratio 2.09 (1.26-3.46); p < 0.001], a reduced number of puncture attempts [2 (1-3) vs. 2 (1-4), B coefficient - 0.51 (95% confidence interval - 1.01 to - 0.03), p = 0.035], and fewer overall mechanical complications [12 vs. 22.5%, odds ratio 0.47 (95% confidence interval 0.24-0.91), p = 0.025] in the matched cohort. The number of puncture attempts was the main factor associated with overall complications.

CONCLUSIONS:

Compared with the landmark technique, ultrasound guidance was associated with an increased first-attempt success rate, a reduced number of puncture attempts, and fewer complications during central venous catheter placement in critically ill children.

KEYWORDS:

Central venous catheterization; Children; Landmark; Paediatric intensive care unit; Ultrasound

PMID:
29196794
DOI:
10.1007/s00134-017-4985-8
[Indexed for MEDLINE]

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