Zhiyang Jace Lin1, York Tien Lee2, Joyce Horng Yiing Chua3, Rachel Wang4, Vanessa Lee4, Sue Mei Cheah5, Seyed Ehsan Saffari6, Joyce Ching Mei Lam7, Amos Hong Pheng Loh8. 1. Flinders University School of Medicine, Flinders University, Adelaide, Australia. 2. Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. 3. Children's Centre, Raffles Hospital, Singapore, Singapore. 4. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 5. Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore. 6. Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore. 7. Department of Paediatric Subspecialties Haematology Oncology Service, KK Women's and Children's Hospital, Singapore, Singapore. 8. Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. amos.loh.h.p@singhealth.com.sg.
Abstract
BACKGROUND: Surgical trainees performing subclavian vein (SCV) cannulation often incorrectly perceive needle trajectory and anatomical relations. As surface landmark-based methods derived from adult surgical practice may be less effective in younger patients, we developed and evaluated a novel bony landmark-based method for teaching SCV cannulation for central venous access device (CVAD) placement in children. METHODS: Over 2 sequential 3-year periods, pediatric surgical trainees were taught infraclavicular SCV cannulation via surface- and bony-landmark approaches, respectively. We prospectively recorded patient, surgeon and operative details on all Hickman line and port-a-cath insertions placed by trainees as the first surgeon via percutaneous infraclavicular SCV puncture and compared procedural outcomes and complications across both periods. RESULTS: Of 271 cases included in the study, trainees performed 52 (50.5%) and 92 (54.8%) procedures in the first and second periods, respectively. Patients in both periods did not differ by gender, disease, CVAD device, or prior CVAD, chemotherapy or infection status. In the second (bony landmark) period, although patients were younger (6.0 vs. 8.7 years, P = 0.003) mean procedural duration was shorter (42.5 vs. 58.3 min, P < 0.001). Also, cannulation attempts and complication rates did not differ significantly between study periods (P = 0.257 and 1.0, respectively). CONCLUSIONS: With the bony landmark approach, trainees could perform the procedures faster despite operating on younger patients, without impacting complication rates and cannulation attempts. Bony landmarks may better approximate SCV position across a range of ages, thus improving the consistency of SCV cannulation in CVAD placements in children.
BACKGROUND: Surgical trainees performing subclavian vein (SCV) cannulation often incorrectly perceive needle trajectory and anatomical relations. As surface landmark-based methods derived from adult surgical practice may be less effective in younger patients, we developed and evaluated a novel bony landmark-based method for teaching SCV cannulation for central venous access device (CVAD) placement in children. METHODS: Over 2 sequential 3-year periods, pediatric surgical trainees were taught infraclavicular SCV cannulation via surface- and bony-landmark approaches, respectively. We prospectively recorded patient, surgeon and operative details on all Hickman line and port-a-cath insertions placed by trainees as the first surgeon via percutaneous infraclavicular SCV puncture and compared procedural outcomes and complications across both periods. RESULTS: Of 271 cases included in the study, trainees performed 52 (50.5%) and 92 (54.8%) procedures in the first and second periods, respectively. Patients in both periods did not differ by gender, disease, CVAD device, or prior CVAD, chemotherapy or infection status. In the second (bony landmark) period, although patients were younger (6.0 vs. 8.7 years, P = 0.003) mean procedural duration was shorter (42.5 vs. 58.3 min, P < 0.001). Also, cannulation attempts and complication rates did not differ significantly between study periods (P = 0.257 and 1.0, respectively). CONCLUSIONS: With the bony landmark approach, trainees could perform the procedures faster despite operating on younger patients, without impacting complication rates and cannulation attempts. Bony landmarks may better approximate SCV position across a range of ages, thus improving the consistency of SCV cannulation in CVAD placements in children.
Authors: Jean-Jacques Parienti; Nicolas Mongardon; Bruno Mégarbane; Jean-Paul Mira; Pierre Kalfon; Antoine Gros; Sophie Marqué; Marie Thuong; Véronique Pottier; Michel Ramakers; Benoît Savary; Amélie Seguin; Xavier Valette; Nicolas Terzi; Bertrand Sauneuf; Vincent Cattoir; Leonard A Mermel; Damien du Cheyron Journal: N Engl J Med Date: 2015-09-24 Impact factor: 91.245
Authors: J-Y Lefrant; L Muller; J-E De La Coussaye; M Prudhomme; J Ripart; C Gouzes; P Peray; G Saissi; J-J Eledjam Journal: Intensive Care Med Date: 2002-07-06 Impact factor: 17.440