Flora Habas1, Julien Baleine1, Christophe Milési1, Clémentine Combes1, Marie-Noëlle Didelot2, Sara Romano-Bertrand3, Delphine Grau3, Sylvie Parer3, Catherine Baud4, Gilles Cambonie5,6. 1. Pediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France. 2. Department of Bacteriology, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France. 3. Department of Hospital Infection Control, Saint Eloi Hospital, Montpellier University Hospital Center, Montpellier, France. 4. Department of Pediatric Radiology, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France. 5. Pediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France. g-cambonie@chu-montpellier.fr. 6. Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France. g-cambonie@chu-montpellier.fr.
Abstract
Placement of a central venous catheter (CVC) in the brachiocephalic vein (BCV) via the ultrasound (US)-guided supraclavicular approach was recently described in children. We aimed to determine the CVC maintenance-related complications at this site compared to the others (i.e., the femoral, the subclavian, and the jugular). We performed a retrospective data collection of prospectively registered data on CVC in young children hospitalized in a pediatric intensive care unit (PICU) during a 4-year period (May 2011 to May 2015). The primary outcome was a composite of central line-associated bloodstream infection (CLABSI) and deep-vein thrombosis (CLAT) according to the CVC site. Two hundred and twenty-five children, with respective age and weight of 7.1 (1.3-40.1) months and 7.7 (3.6-16) kg, required 257 CVCs, including 147 (57.2%) inserted in the BCV. The risk of the primary outcome was lower in the BCV than in the other sites (5.4 vs 16.4%; OR: 0.29; 95% CI: 0.12-0.70; p = 0.006). CLABSI incidence density rate (2.8 vs 8.96 per 1000 catheter days, p < 0.001) and CLAT incidence rate (2.7 vs 10%, p = 0.016) were also lower at this site. CONCLUSION: BCV catheterization via the US-guided supraclavicular approach may decrease CVC maintenance-related complications in children hospitalized in a PICU. What is Known: • Placement of a central venous catheter (CVC) in children is associated with mechanical risks during insertion, and with infectious and thrombotic complications during its maintenance. • Ultrasound (US)-guided supraclavicular catheterization of the brachiocephalic vein (BCV) is feasible in infants and children. What is New: • This observational study suggested that BCV catheterization via the US-guided supraclavicular approach was associated with a lower risk of CVC insertion and maintenance-related complications, compared with the other catheterization sites.
Placement of a central venous catheter (CVC) in the brachiocephalic vein (BCV) via the ultrasound (US)-guided supraclavicular approach was recently described in children. We aimed to determine the CVC maintenance-related complications at this site compared to the others (i.e., the femoral, the subclavian, and the jugular). We performed a retrospective data collection of prospectively registered data on CVC in young children hospitalized in a pediatric intensive care unit (PICU) during a 4-year period (May 2011 to May 2015). The primary outcome was a composite of central line-associated bloodstream infection (CLABSI) and deep-vein thrombosis (CLAT) according to the CVC site. Two hundred and twenty-five children, with respective age and weight of 7.1 (1.3-40.1) months and 7.7 (3.6-16) kg, required 257 CVCs, including 147 (57.2%) inserted in the BCV. The risk of the primary outcome was lower in the BCV than in the other sites (5.4 vs 16.4%; OR: 0.29; 95% CI: 0.12-0.70; p = 0.006). CLABSI incidence density rate (2.8 vs 8.96 per 1000 catheter days, p < 0.001) and CLAT incidence rate (2.7 vs 10%, p = 0.016) were also lower at this site. CONCLUSION: BCV catheterization via the US-guided supraclavicular approach may decrease CVC maintenance-related complications in children hospitalized in a PICU. What is Known: • Placement of a central venous catheter (CVC) in children is associated with mechanical risks during insertion, and with infectious and thrombotic complications during its maintenance. • Ultrasound (US)-guided supraclavicular catheterization of the brachiocephalic vein (BCV) is feasible in infants and children. What is New: • This observational study suggested that BCV catheterization via the US-guided supraclavicular approach was associated with a lower risk of CVC insertion and maintenance-related complications, compared with the other catheterization sites.
Authors: Marlene R Miller; Michael Griswold; J Mitchell Harris; Gayane Yenokyan; W Charles Huskins; Michele Moss; Tom B Rice; Debra Ridling; Deborah Campbell; Peter Margolis; Stephen Muething; Richard J Brilli Journal: Pediatrics Date: 2010-01-11 Impact factor: 7.124
Authors: Ignacio Oulego-Erroz; Almudena Alonso-Ojembarrena; Victoria Aldecoa-Bilbao; María Del Carmen Bravo; Jon Montero-Gato; Rocío Mosqueda-Peña; Antonio Rodríguez Nuñez Journal: Eur J Pediatr Date: 2022-03-17 Impact factor: 3.183