ABSTRACT 503

Abstract

Background and aims: CVC is widely used in PICU for resuscitation, nutritional support, and long-term vascular access.Young children are more susceptible to mechanical complications of CVC insertion than adolescents or adults.Technical knowledge of deep anatomy minimizes complications and the adequate positioning. Aims: 1) Descriptive analysis of the CVCs inserted in our PICU; 2) Correlation of the adequate position of the CVC by anatomic landmarks and confirmation thorax radiography; 3) Analysis of CVC insertion complications. Methods: Retrospective chart review of all patients admitted in a private,tertiary PICU between July 2012-July 2013.Age, sex, primary reason for CVC insertion, access site, type of catheter, complications and positioning adequacy with thorax radiography were analyzed. Arterial insertion, pneumothorax, thrombosis, catheter infection and obstruction were the complications analyzed. The correct position of the catheter tip in the X-ray was considered in the junction of superior vena cava (SVC)and right atrium.The study was approved by IRB. Results: Records of 141 cannulations were evaluated in 122 patients. Of the 122 patients, 75 (61,5%) were males. Median age was 3,5 years (1 month to 18,3 years). Primary reason for insertion was: absence of peripheric access 56 (45,9%), post-surgical 34 (27,8%), shock 21 (17,2%) and oncologic 11 (9,1%). Malpositions occurred in 15 (10,6%) patients. Access sites were internal jugular vein 74 (52,5%), subclavian vein 10 (7,1%), femoral vein 8(5,7%) and PICC 49 (34,7%). Type of catheters inserted included short-term 86 (70,5%), long-term (7,3%) and PICC (40,1%). There were 2 catheter-related infections,no pneumothorax, 1 arterial insertion, 3 obstructions and 4 catheter-related thrombosis. Conclusions: Incidence of malposition and complications was low in our population when compared with the literature.One reason for lesser complications was the use of ultrasound to guide the venous catheter insertion.