Paediatric Central Venous Access: Experience in the Largest South African Paediatric Surgical Centre

Abstract

ABSTRACT Background: Percutaneous central venous catheterization (CVC) in the paediatric population is a relatively common procedure but local data in South Africa are extremely limited. Objective: To describe percutaneous CVC in the local setting with regard to patient population demographics, health care professionals performing the procedure, techniques, and immediate complications of the procedure. Methods: A prospective descriptive study of CVC was performed at Chris Hani Baragwanath Academic Hospital from 1 May 2017 to 31 July 2017. Results: A total of 129 CVCs were inserted. Complete data were collected on 95 placements. Median patient age was 60 days (range: 1–5760). The majority of CVCs occurred in surgical patients (78/95, 82%). Irritant drugs (31/95, 33%), fluid administration (27/95, 28%), and failure to establish peripheral intravenous access (16/95, 17%) were the most common indications for CVC. The immediate mechanical complication rate was 13% (12/95). No statistical difference was found in complication rates between line placement by junior and senior staff, between the subclavian and internal jugular routes, between patients with previous CVC access and those without, and between intubated and awake patients. The majority of CVC were placed in the neonatal unit (55%, 52/95), without the use of ultrasound guidance (100%, 95/95), and outside of the operating theatre (74%, 70/95). Conclusions: Immediate mechanical complication rates are comparable to international figures. The high number of CVCs necessitates the establishment of a vascular access service that identifies those patients at high risk of requiring CVC early, relieves the paediatric surgical service of the high burden of CVC, and actively pursues safer and less resource intensive alternatives to CVC.