Do not trust landmarks and your feelings while inserting pediatric central venous catheters

Abstract

Background Central venous catheterization (CVC) is a commonly used procedure in pediatric surgery and intensive care units. For some reasons, catheterizations in children are technically more difficult in comparison to adult patients. The purpose of this study is to evaluate the CVC procedures performed with the aid of anatomic landmarks by experienced (35, 14, 4 years of experience) anesthesiologists and the associated complications. A total of 498 cases under the age of 18 who underwent CVC (temporary, port, or Hickman) between the years 2014 and 2017 were included in this retrospective study. All catheters were inserted with the aid of anatomic landmarks. Results The mean age of the patients was 47.1 ± 59.2 months and 54.8% were male. By using anatomical landmarks, the average success rate in central venous catheterizations was calculated as 98.6%. Complications developed included arterial puncture in 8% (n 40), temporary arrhythmia in 6.2% (n 31) and pneumothorax in 1.4% (n 7) of the patients. Only using multiple punctures (p = 0.005) and catheterizations lasting more than 10 min (the time to blood return from the catheter, p = 0.017) were found to be associated with complications. The experience of the practitioner had no effect on the development of complications (p = 0.354). Conclusions In CVCs using anatomic landmarks, complications are seen more frequently in children. Even though a decrease in overall complication rates was detected in catheterizations performed by experienced hands, it is seen that experience does not eliminate complications in CVC insertions using anatomic landmarks.

Comparison of ultrasound-guided central venous catheterization versus anatomical landmarks in pediatric critically ill patients: a prospective study

“…Por lo tanto, es esencial que los métodos utilizados para estos procedimientos sean tanto eficaces como seguros. (6,7) Históricamente, el enfoque convencional para la inserción de CVC ha sido el método de las referencias anatómicas, que depende de la experiencia del médico y su familiaridad con la anatomía del paciente. Sin embargo, este método tiene sus limitaciones, incluyendo el riesgo de complicaciones mecánicas, como la punción arterial inadvertida y la formación de hematomas.…”