Allison F Linden1,2, Chase Corvin3, Keva Garg3, Richard R Ricketts4, A Alfred Chahine5,6. 1. Section of Pediatric Surgery, Department of Surgery, University of Chicago Medicine, 5839 South Maryland Avenue, Rm. A-426, MC4062, Chicago, IL, 60637, USA. Alli.Linden@gmail.com. 2. Department of Surgery, Medstar Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC, 20007, USA. Alli.Linden@gmail.com. 3. Georgetown University School of Medicine, 3900 Reservoir Road, NW, Washington, DC, 20057, USA. 4. Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, 1405 Clifton Road, Atlanta, GA, 30322, USA. 5. Department of Surgery, Medstar Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC, 20007, USA. 6. Division of General and Thoracic Surgery, Children's National Health System, 111 Michigan Avenue, NW, Washington, DC, 20010, USA.
Abstract
PURPOSE: To assess the indications, safety and outcomes of tunneled central venous catheters (CVCs) placed via a cutdown approach into the axillary vein in children, an approach not well described in this population. METHODS: A retrospective cohort study was performed on pediatric patients who received CVCs via open cannulation of the axillary vein or one of its tributaries between January 2006 and October 2016 at two hospitals. RESULTS: A total of 24 axillary CVCs were placed in 20 patients [10 male (42%); mean weight 7.0 kg (SD 2.9); mean age 10 months (SD 6)]. The most common indications for axillary vein access included neck or chest wall challenges (tracheostomies or chest wall wounds) (n = 18). The median duration of line placement was 140 days (IQR 146). The most common indications for removal were completion of therapy (n = 7, 39%) and infection (n = 5, 28%). There were no early complications. Long-term complications included infection (n = 5) or catheter malfunction (n = 3). CONCLUSIONS: Tunneled CVC placement via a cutdown approach into the axillary vein or its tributary can be an effective alternative approach to obtain long-term vascular access in children. Outcomes may be comparable to lines placed in traditional internal jugular and subclavian vein locations.
PURPOSE: To assess the indications, safety and outcomes of tunneled central venous catheters (CVCs) placed via a cutdown approach into the axillary vein in children, an approach not well described in this population. METHODS: A retrospective cohort study was performed on pediatric patients who received CVCs via open cannulation of the axillary vein or one of its tributaries between January 2006 and October 2016 at two hospitals. RESULTS: A total of 24 axillary CVCs were placed in 20 patients [10 male (42%); mean weight 7.0 kg (SD 2.9); mean age 10 months (SD 6)]. The most common indications for axillary vein access included neck or chest wall challenges (tracheostomies or chest wall wounds) (n = 18). The median duration of line placement was 140 days (IQR 146). The most common indications for removal were completion of therapy (n = 7, 39%) and infection (n = 5, 28%). There were no early complications. Long-term complications included infection (n = 5) or catheter malfunction (n = 3). CONCLUSIONS: Tunneled CVC placement via a cutdown approach into the axillary vein or its tributary can be an effective alternative approach to obtain long-term vascular access in children. Outcomes may be comparable to lines placed in traditional internal jugular and subclavian vein locations.
Entities:
Keywords:
Axillary vein; Central venous line placement
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