Supraclavicular catheterization of the brachiocephalic vein: a way to prevent or reduce catheter maintenance-related complications in children

Habas, Flora; Baleine, Julien; Milési, Christophe; Combes, Clémentine; Didelot, Marie-Noëlle; Romano-Bertrand, Sara; Grau, Delphine; Parer, Sylvie; Baud, C.; Cambonie, Gilles

doi:10.1007/s00431-017-3082-x

Cited by 36 publications

(45 citation statements)

References 30 publications

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“…Apart from one catheter obstruction, no long‐term complication was reported in this series. This is in accordance with two previous studies demonstrating lower rates of infection, catheter obstruction, and symptomatic deep vein thrombosis for brachiocephalic venous catheters compared to internal jugular and femoral venous catheters in babies 16,17 . Two of our previous studies demonstrated a poor sonographic view of the right BCV, at times showing only a circular appearance due a particularly steep run (Figure 4).…”

Section: Discussionsupporting

confidence: 92%

Feasibility of the ultrasound‐guided supraclavicular cannulation of the brachiocephalic vein in very small weight infants: A case series

Breschan

Graf

Arneitz

et al. 2020

Pediatric Anesthesia

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Background The aim of this retrospective analysis was to evaluate the clinical feasibility of the supraclavicular ultrasound‐guided cannulation of the brachiocephalic vein in infants weighing less than 1500 g. Methods The ultrasound probe was placed in the supraclavicular region so as to obtain the optimum sonographic long‐axis view of the brachiocephalic vein. By using an in‐plane approach the brachiocephalic vein was cannulated by using a 24‐gauge intravenous cannula under real‐time ultrasound guidance into the vein followed by the insertion of a 2‐French single lumen catheter using the Seldinger technique. Results Forty‐six brachiocephalic vein cannulations in infants weighing between 0.55 and 1.5 kg (Median: 1.2; 95%‐CI: 0.9‐1.2) were included. Ultimate success rate was 89.1% (41 out of 46). One cannulation attempt was required in 30 (65.2%) patients, 2 in 6 (13%) and 3 in 5 (10.8%), respectively. Smaller weight babies did not require significantly more cannulation attempts. The probability of successful cannulation on the first attempt increased significantly from 40% (2010) to more than 80% (2019) over the time course of this series. Median catheter dwell time was 15 days (95%‐CI: 9‐20) with one catheter being removed prematurely after 8 days due to obstruction. Conclusion Supracalvicular in‐plane real‐time ultrasound‐guided cannulation of the brachiocephalic vein seems to be a convenient and feasible option to provide large‐bore central venous access for very small and sick babies.

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Section: Discussionsupporting

confidence: 92%

Feasibility of the ultrasound‐guided supraclavicular cannulation of the brachiocephalic vein in very small weight infants: A case series

Breschan

Graf

Arneitz

et al. 2020

Pediatric Anesthesia

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“…132 Comparatively, brachiocephalic insertion sites were associated with significantly lower CLABSI and thrombosis compared to jugular and subclavian approaches. 69 Overall, CVAD insertion through the femoral vein was linked to higher risk of thrombosis 51,67,89 but lower complication and infection rates in infants ,5 kg. 85…”

Section: Recommendations For Insertion Insertion Locationsmentioning

confidence: 97%

“…113 Across CVAD types, insertion via the internal jugular in infants and pediatric patients was associated with increased risk of high arterial puncture, 42,113 postoperative chylothorax, 36 thrombosis, 67,69,89 and infection. 42,69 Insertion through the subclavian vein was correlated with an increased risk of high arterial puncture (left-side approaches), 42,113 arrhythmias and misplacement (right-side approaches), 113 malposition and occlusion, 42 postoperative chylothorax, 36 and sepsis. 31 In pediatric oncology patients, subclavian insertion sites had higher rates of thrombosis compared to external jugular and cephalic sites, but there was no difference in rates between right-or left-side insertion sites.…”

Section: Recommendations For Insertion Insertion Locationsmentioning

confidence: 99%

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

et al. 2020

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OBJECTIVE: To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs). DATA SOURCES: Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases. STUDY SELECTION: Clinical practice guidelines, systematic reviews, cohort designs, randomized control trials (RCTs), quasi RCTs, before-after trials, or case-control studies that reported on complications and/or risk as well as reliability of VADs in patients aged 0 to 18 years were included. DATA EXTRACTION: Articles were independently reviewed to extract and summarize details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications. RESULTS: VAD selection and insertion decision-making in general hospitalized and some specialized patient populations were well evidenced. The use of single-lumen devices and ultrasound-guided techniques was also broadly supported. There was a lack of RCTs, and for neonates, cardiac patients, patients with difficult venous access, midline catheters, catheter-tovein ratio, and near-infrared devices, the lack of evidence necessitated broadening the review scope. LIMITATIONS: Limitations include the lack of formal assessment of the quality of evidence and the lack of RCTs and systematic reviews. Consequently, clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations. CONCLUSIONS: This is the first synthesis of available evidence for the selection and insertion of VADs in pediatric patients and is important for determining the appropriateness of VADs in pediatric patients. WHAT'S KNOWN ON THIS SUBJECT: Individual studies, systematic reviews, and focused clinical practice guidelines that evaluate vascular access devices (VADs) in various pediatric populations are available. However, to date, no systematic review examining the appropriateness, and inappropriateness, of VADs across common pediatric clinical scenarios exists. WHAT THIS STUDY ADDS: There is strong evidence to support and facilitate appropriate clinical decision-making in some pediatric indications. However, certain populations, device types and characteristics, and insertion procedures are poorly evidenced, necessitating the application of clinical judgment for VAD decision-making.

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“…Ultrasound-guided cannulation of the BCV is associated with a higher rate of first attempt success and fewer cannulation attempts compared to other approaches [ 231 , 232 ]. The accidental arterial puncture rate was not significantly different between internal jugular and subclavian vein cannulation [ 227 , 228 ], but was lower for BCV cannulation [ 229 ]. The study by Lu et al was not included in this analysis, as BCV cannulation was not ultrasound-guided in 2001 [ 230 ].…”

Section: Summary Of the Resultsmentioning

confidence: 99%

“…The study by Lu et al was not included in this analysis, as BCV cannulation was not ultrasound-guided in 2001 [ 230 ]. Very low pneumothorax rates were reported in the various studies (all cases of pneumothorax were observed with classical subclavian vein cannulation); no cases of pneumothorax were observed with the BCV in two case series and one comparative study [ 225 , 226 , 229 ]. Subclavian vein cannulation was associated with higher rates of guidewire misplacement and catheter malposition with a high level of evidence [ 227 , 228 , 231 , 232 ], as access is more direct for femoral veins, right jugular veins and both brachiocephalic veins.…”

Section: Summary Of the Resultsmentioning

confidence: 99%

Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

Timsit

Baleine

Bernard

et al. 2020

Ann. Intensive Care

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125

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The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections’ prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing gets detached, soiled or impregnated with blood (GRADE 2− adults). CHG dressings should likely be used (GRADE 2+). For adults and children, ultrasound guidance should be used to reduce mechanical complications in case of internal jugular access (GRADE 1), subclavian access (Grade 2) and femoral venous, arterial radial and femoral access (Expert opinion). For children, an ultrasound-guided supraclavicular approach of the brachiocephalic vein was recommended to reduce the number of attempts for cannulation and mechanical complications. Based on scarce publications on diagnostic and therapeutic strategies and on their experience (expert opinion), the panel proposed definitions, and therapeutic strategies.

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Supraclavicular catheterization of the brachiocephalic vein: a way to prevent or reduce catheter maintenance-related complications in children

Cited by 36 publications

References 30 publications

Feasibility of the ultrasound‐guided supraclavicular cannulation of the brachiocephalic vein in very small weight infants: A case series

Feasibility of the ultrasound‐guided supraclavicular cannulation of the brachiocephalic vein in very small weight infants: A case series

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

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