Retrospective Assessment of Patient and Catheter Characteristics Associated With Malpositioned Central Venous Catheters in Pediatric Patients

Weber, Mark; Conlon, Thomas; Woods-Hill, Charlotte; Watts, Stephanie; Nelson, Eileen; Traynor, Danielle; Zhang, Bingqing; Davis, Daniela; Himebauch, Adam S.

doi:10.1097/pcc.0000000000002882

Cited by 3 publications

(7 citation statements)

References 41 publications

(42 reference statements)

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“…In our study cohort, over two-thirds of patients received a CVC, half of whom were in the ED, and the other half having one placed later in the OR or ICU. CVC-related mechanical complications occurred in 17.2% of puncture attempts (15.5% of patients), which is in line with the results of previous studies ranging from 1.3% [ 41 ], 3.3% [ 42 ], 12.8% [ 43 ], 14.1% [ 44 ], 20.2% [ 45 ] 25% and 31% [ 46 ] up to 38.4% [ 47 ]. Mechanical complications and malposition had no relevant impact on the treatment course, supporting other studies in the pediatric population and adult trauma population of our study center, in which we found considerable malposition rates of almost 30% [ 47 , 48 ].…”

Section: Discussionsupporting

confidence: 90%

Epidemiological Analysis of the Emergency Vascular Access in Pediatric Trauma Patients: Single-Center Experience of Intravenous, Intraosseous, Central Venous, and Arterial Line Placements

et al. 2023

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Vascular access in severely injured pediatric trauma patients is associated with time-critical circumstances and low incidences, whereas only scarce literature on procedure performance is available. The purpose of this study was to analyze the performance of different vascular access procedures from the first contact at the scene until three hours after admission. Intubated pediatric trauma patients admitted from the scene to a single Level I trauma center between 2008 and 2019 were analyzed regarding intravenous (IV) and intraosseous (IO) accesses, central venous catheterization (CVC) and arterial line placement. Sixty-five children with a median age of 14 years and median injury severity score of 29 points were included, of which 62 (96.6%) underwent successful prehospital IV or IO access by emergency medical service (EMS) physicians, while it failed in two children (3.1%). On emergency department (ED) admission, IV cannulas of prehospital EMS had malfunctions or were dislodged in seven of 55 children (12.7%). IO access was performed in 17 children without complications, and was associated with younger age, higher injury severity and higher mortality. Fifty-two CVC placements (58 attempts) and 55 arterial line placements (59 attempts) were performed in 45 and 52 children, respectively. All CVC and arterial line placements were performed in the ED, operating room (OR) and intensive care unit (ICU). Ten mechanical complications related to CVC placement (17.8%) and seven related to arterial line placement (10.2%) were observed, none of which had outcome-relevant consequences. This case series suggests that mechanical issues of vascular access may frequently occur, underlining the need for special preparedness in prehospital, ED, ICU and OR environments.

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Section: Discussionsupporting

confidence: 90%

Epidemiological Analysis of the Emergency Vascular Access in Pediatric Trauma Patients: Single-Center Experience of Intravenous, Intraosseous, Central Venous, and Arterial Line Placements

et al. 2023

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“…The carina is suggested as an anatomical landmark for CVC tip position that can be easily identified on X‐ray images in many studies 26,27 . The optimal position of the catheter tip has been assumed to be at the level of the carina or to be within 1.5 cm proximal of it 4,18–21 . We assigned this ideal position of the catheter tip to level 2 in our classification of the X‐ray images.…”

Section: Discussionmentioning

confidence: 99%

“…We first assessed the depth of insertion of the CVC. The optimal catheter tip position was assumed to be at the level of the carina or within 1.5 cm proximal thereof 4,18–21 . For this purpose, we defined three levels of the position of the CVC tip in the chest X‐ray (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…The optimal catheter tip position was assumed to be at the level of the carina or within 1.5 cm proximal thereof. 4,[18][19][20][21] For this purpose, we defined three levels of the position of the CVC tip in the chest X-ray (Figure 1). Level 1: Insertion not deep enough, CVC tip projection above the dorsal portion of the 4th rib.…”

Section: Evaluation Of Cvc Tip Positionmentioning

confidence: 99%

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Ultrasound‐guided supraclavicular cannulation of left brachiocephalic versus right internal jugular vein: Comparative analysis of central venous catheter‐associated complications

Falay

Schindler

Mikus

et al. 2022

Pediatric Anesthesia

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Aims Central venous catheters are essential for the management of pediatric cardiac surgery patients. Recently, an ultrasound‐guided access via a supraclavicular approach to the brachiocephalic vein has been described. Central venous catheters are associated with a relevant number of complications in pediatric patients. In this study, we evaluated the frequency of complications of left brachiocephalic vein access compared with right internal jugular vein standard access in children undergoing cardiac surgery. Methods Retrospective analysis of all pediatric cases at our tertiary care university hospital over a two‐year period receiving central venous catheters for cardiac surgery. Primary endpoint: Frequency of complications associated with central venous catheters inserted via the left brachiocephalic vein vs. right internal jugular vein. Complications were defined as: chylothorax, deep vein thrombosis, sepsis, or delayed chest closure. Secondary endpoints: Evaluation of the insertion depth of the catheter using a height‐based formula without adjustment for side used. Results Initially, 504 placed catheters were identified. Following inclusion and exclusion criteria, 480 placed catheters remained for final analysis. Overall complications were reported in 68/480 (14.2%) cases. There was no difference in the frequency of all complications in the left brachiocephalic vein vs. the right internal jugular vein group (15.49% vs. 13.65%; OR = 1.16 [0.64; 2.07]), nor was there any difference considering the most relevant complications chylothorax (7.7% vs. 8.6%; OR = 0.89 [0.39; 1.91]) and thrombosis (5.6% vs. 4.5%; OR = 1.28 [0.46; 3.31]). The mean deviation from the optimal insertion depth was left brachiocephalic vein vs. right internal jugular vein 5.38 ± 13.6 mm and 4.94 ± 15.1 mm, respectively. Conclusions Among children undergoing cardiac surgery, there is no significant difference between the supraclavicular approach to the left brachiocephalic vein and the right internal jugular vein regarding complications. For both approaches, a universal formula can be used to determine the correct insertion depth.

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“…The appropriate position of the catheter tip was from the inferior third of the superior vena cava to the opening of the right atrium [3]. Chest X-ray showed that the appropriate position was the carinal process to the two vertebral bodies below it [4], about at T4-T6.…”

Section: Introductionmentioning

confidence: 99%

Effect of improved right subclavian vein catheterization on the direction of catheter tip in children

Wang

Chen

Zhao

et al. 2023

Preprint

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Background. Catheter tip malposition frequently occurs with subclavian vein catheterization.The supine position returns more and faster blood to the heart than the head down position.It is assumed that the soft catheter is easy to follow the flow forward. This study investigates the influence of catheter flexibility and position on right subclavian catheter placement. Methods. Patients who required subclavian venipuncture catheterization at the Department of Hematology and oncology, Shenzhen Children's hospital were randomly divided into two groups: test group A (80 patients) vs control group B (81 patients).Group A was in the flat position, and the guide wire was partially retracted during catheter placement.Group B used the traditional method of catheterization.Intraoperative ultrasound was used to check the direction of the catheter tip and postoperative chest X-ray was performed. Results. The correct rate of catheter tip orientation at the first insertion in group A was higher than that in group B (86.2% vs 66.7%, P < 0.05), and the rate of catheter misplacement in right internal jugular vein in group A was lower than that in group B (10.0% vs 29.6%, P < 0.05). The incidence of intraoperative arrhythmia in group A was lower than that in group B (0.0% vs 14.8%, P < 0.05).No significant differences in general data and other complications between them. Repeated catheterization failed in 5 patients,and other methods were used for catheterization. Conclusions. The use of the guide wire in the supine position can reduce catheter malposition in children with right subclavian vein catheterization.

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Retrospective Assessment of Patient and Catheter Characteristics Associated With Malpositioned Central Venous Catheters in Pediatric Patients

Abstract: The primary objective was to determine the prevalence and characteristics associated with malpositioned temporary, nontunneled central venous catheters (CVCs) placed via the internal jugular (IJ) and subclavian (SC) veins in pediatric patients.

Cited by 3 publications

References 41 publications

Epidemiological Analysis of the Emergency Vascular Access in Pediatric Trauma Patients: Single-Center Experience of Intravenous, Intraosseous, Central Venous, and Arterial Line Placements

Epidemiological Analysis of the Emergency Vascular Access in Pediatric Trauma Patients: Single-Center Experience of Intravenous, Intraosseous, Central Venous, and Arterial Line Placements

Ultrasound‐guided supraclavicular cannulation of left brachiocephalic versus right internal jugular vein: Comparative analysis of central venous catheter‐associated complications

Effect of improved right subclavian vein catheterization on the direction of catheter tip in children

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