Percutaneous subclavian venous catheters in neonates and children

Eichelberger, Martin R.; Rous, Peter G.; Hoelzer, Dennis J.; Garcia, Victor F.; Koop, C. Everett

doi:10.1016/0022-3468(81)90003-8

Cited by 49 publications

(27 citation statements)

References 7 publications

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“…This was the onIy neonate who died due to a catheter related complication. The 2.3% incidence of septic complications was low compared to the incidence of 2.5% to 40% reported in the literature (Eichelberger et al 1981;Sitzmann, Townsend & Siler 1985). This low incidence may result from careful and sterile h.andling of the catheter and the performance of routine bacterial cultures.…”

Section: Discussioncontrasting

confidence: 52%

Central venous catheters in neonates less than 3500 g—results of a prospective study

Schimpl

Weber

Pfleger

et al. 1994

Pediatric Anesthesia

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In this prospective study we analysed 336 consecutive central venous catheters in neonates less than 3500 g. A protocol standardizing the technique of insertion, the care of the catheter, the preparation of solutions and weekly bacteriological screening was applied to all catheter insertions. Mechanical complications were observed in 15 (6%), catheter dislodgement (5%), obstruction (8%), perforation (2%) and caval vein thrombosis (0.6%). Routine bacteriological cultures of feeding solutions and infusion devices showed a contamination rate of 3.5% and 2%. Skin swab and catheter tip cultures after catheter removal demonstrated positive results in 6% and 4.7%, but catheter related sepsis occurred in only 2.3%. Staphylococcus epidermidis was found in 81 % of all positive bacterial cultures. Four point seven per cent of catheters were removed for suspected infection though only one third of them produced a bacteriological growth. We conclude that the risk of mechanical complications and contamination of central venous catheters in neonates can be minimized by the use of a standardized protocol.

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Section: Discussioncontrasting

confidence: 52%

Central venous catheters in neonates less than 3500 g—results of a prospective study

Schimpl

Weber

Pfleger

et al. 1994

Pediatric Anesthesia

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“…The incidence of catheter-related sepsis in large pediatric series varies from 1.4 to 5.8% [2,5]. A careful assessment of suspected catheter-related infection is important since this was responsible for the removal of 11.6% of catheters in our case series, while in only 2 (1.3%) of these cases catheter-related sepsis was confirmed by cultures.…”

Section: Discussionmentioning

confidence: 79%

“…The literature shows that the venous catheter inserted through a wide bore needle (Intracath Ò ) is still widely used [3][4][5]; however, this technique and the venous dissection are associated with high morbidity, particularly among pediatric patients [6]. Traditionally, anatomic landmarks have been used to locate the central veins for catheterization.…”

Section: Introductionmentioning

confidence: 99%

Central venous catheter placement in children: a prospective study of complications in a Brazilian public hospital

2006

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Central venous access is frequently used in infants and children with a wide variety of conditions. This report evaluates our experience and the complications from central venous catheters (CVC) placed percutaneously in children at a public hospital of a developing country-Brazil. To identify associated complications, data were collected prospectively and 155 consecutive catheterizations in children at a public hospital over a nearly 8-month period were analyzed. Data collected included sex, age, weight, primary diagnosis, indication for placement, presence of blood coagulation disturbance, hospital department for procedure, type of anesthesia, type of catheter (diameter, lumen number, material), site of catheterization, number of attempts, number of puncture sites, complications during puncture, the time catheter remained in place, later complications (mechanical, infectious) and reason for catheter removal. A total of 155 catheters were placed in 127 patients. There were 130 neck lines and 25 groin lines. The success rate was 81.9% at the initially chosen puncture site and rose to 100% with the inclusion of the second site. Perioperative complications occurred in nine (5.8%) cases, including six (3.9%) hematomas and three (1.9%) arterial puncture. There was no pneumothorax, hemothorax or hydrothorax. During the time the catheter remained in place, there were 51 (32.9%) complications, of which 33 (21.3%) were mechanical and 18 (11.6%) suspected catheter-related infection. These complications were responsible for the removal of the catheter. Despite the relatively high complication rate there were no catheter-related deaths. Body weight was significantly lower for children who underwent more than one puncture site (P=0.01). Age, sex, type of catheter and primary diagnosis were not associated with complications. Knowledge of anatomy and familiarity with the Seldinger technique highly increase the catheterization success rate, with few surgical complications. A better nursing care of CVC is emphasized. The available modern venous catheters at a public hospital in Brazil have contributed to improve the quality of pediatric medical care. Nowadays, the percutaneous CVC is the preferred method in pediatric patients.

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“…In 23% neonates CRBSI was due to CoNS, which was similar to other studies. 2,[21][22][23][24][25][26] Although amoxicillin is not commonly used as a prophylactic antibiotic in routine NICU practice to prevent CRBSI, Harms et al 19 tested it. This study 19 was underpowered and did not show any significant reduction in the incidence of CRBSI, thus, the role of amoxicillin, in the prevention of CRBSI is questionable.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic antibiotics in the prevention of catheter-associated bloodstream bacterial infection in preterm neonates: a systematic review

et al. 2008

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Objective: To evaluate the efficacy of prophylactic antibiotics in preventing infection associated with central venous catheters in preterm neonates.Study Design: The search strategy of the Cochrane Neonatal Review Group was used. The following databases were searched: Medline, Cochrane Central Register of Controlled Trials, CINAHL and EMBASE. In addition, we hand-searched abstracts of Pediatric Academic Societies annual meetings published in Pediatric Research (1990 to July 2007 and Canadian Pediatric Society annual meeting proceedings (1990( to July 2007. No language restrictions were applied. Included were randomized controlled trials of antibiotics given prophylactically to prevent infection in preterm infants (<37 completed weeks) less than 1-month old admitted to neonatal intensive care units. Both centrally or peripherally inserted central venous catheters were included. Assessment of methodological quality and extraction of data for included trials was undertaken independently by two authors. When suitable, data from trials were combined in a meta-analysis.Result: A total of three studies were found which addressed the role of prophylactic antibiotics to prevent catheter-related infection in neonates. Two studies used vancomycin as the prophylactic antibiotic and one study used amoxicillin. The meta-analysis of studies that used vancomycin had shown an absolute risk reduction of infection from 23 to 2.4%, which yields a number needed to treat equal to 5 (P ¼ 0.0001). Total duration of catheter stay and mortality, were both similar in the vancomycin and control groups. In the amoxicillin study, catheter-related sepsis was not significantly different between the treatment and control groups (P ¼ 0.40). The rate of colonization, however, was significantly higher in the control group (relative risk 0.48; 95% CI 0.12, 1.35). The incidence of necrotizing enterocolitis, intracranial hemorrhage, thrombosis and deaths were not statistically significant between groups.Conclusion: Prophylactic vancomycin appeared to be effective in preventing catheter-related sepsis in preterm neonates. The potential risks, however, of the emergence of resistance because of prophylactic antibiotics, and their continued effectiveness, need further evaluation, before routine use can be recommended.

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Percutaneous subclavian venous catheters in neonates and children

Cited by 49 publications

References 7 publications

Central venous catheters in neonates less than 3500 g—results of a prospective study

Central venous catheters in neonates less than 3500 g—results of a prospective study

Central venous catheter placement in children: a prospective study of complications in a Brazilian public hospital

Prophylactic antibiotics in the prevention of catheter-associated bloodstream bacterial infection in preterm neonates: a systematic review

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