Central Venous Catheters In Pediatric Patients Research Articles

Ethanol Lock Therapy for the Prevention of Nontunneled Catheter-Related Bloodstream Infection in Pediatric Patients.

Ethanol lock therapy (ELT) has been reported as being effective in preventing central line-associated bloodstream infection (CLABSI) in tunneled (or long-term) central venous catheters (CVCs). To the best of our knowledge, no studies have evaluated this therapy in relation to nontunneled (or short-term) CVCs. To evaluate the effectiveness of ELT in preventing CLABSI in nontunneled CVC in pediatric patients. This randomized clinical trial was conducted with children aged 0-5 years and >2 kg in weight, in whom a double-lumen polyurethane nontunneled CVC had been inserted. Patients with catheters inserted in an emergency situation, critically ill patients, and/or those with a history of hypersensitivity or allergic reactions to ethanol were excluded from the study. The variables evaluated were CLABSI, etiological agents, adverse events, and the mechanical effects of ethanol on the catheter (breakage and obstruction). The CLABSI rate was lower in the ELT group compared with the control group (P = 0.0177). However, when the occurrence of CLABSI was evaluated per 1000 catheter-days, no significant difference was found between the groups (P = 0.077). The frequency of side effects and catheter breakage was greater in the ELT group (P = 0.0001 and P = 0.0005, respectively). The CLABSI rate was statistically significantly reduced in the ELT group compared with the controls, but the analysis of frequency per catheter-day showed no significant difference between the groups. Thus, we should not recommend ELT for CLABSI prophylaxis in nontunneled polyurethane CVC, which requires further clinical trials.

The changing profile of safe techniques for the insertion of a central venous catheter in pediatric patients – improvement in the outcome with the experiences of 500 insertions in a single institution

BackgroundThe ability to safely insert a central venous catheter (CVC) is critical to avoid associated complications. The aim of this study was to explore appropriate technique to maintain the safety of pediatric patients during CVC. MethodsWe reviewed the surgical records of CVC insertion techniques and associated complications of 503 tunneled CVC insertions performed from 2000 to 2015. ResultsTwo hundred thirty CVCs (45.7%) were inserted into the subclavian vein using the landmark technique for 10years (first period). Only two pneumothoraxes (0.9%) were experienced. In 2009, we adopted ultrasound-guided venous catheterization from the internal jugular vein, and 103 CVCs (20.5%) were inserted (second period). This procedure led to penetration into the innominate vein (1.0%) by dilater sheath. Patient underwent repair of the penetrated vessel. After this serious complication, 170 CVCs (33.8%) were inserted using the venous cutdown procedure except two catheters. We had two cases whose accessible veins were occluded because of frequent catheterization using venous cutdown technique. No mechanical complications were experienced. ConclusionsThe venous cutdown method is the safest technique for inserting a tunneled CVC in pediatric patients. However, multiple vein occlusions because of repeated catheterizaion by venous cutdown lead to the exhaustion of accessible vessels. Level of evidenceTreatment Study – Level IV

Ultrasonographic measurement of subclavian vein diameter and regression modeling in pediatric patients from a single Korean facility.

Central venous catheterization (CVC) is vital for anesthetic management in pediatric patients undergoing major surgery [1]. The internal jugular vein (IJV), subclavian vein (SCV), and femoral vein are the most commonly used sites for CVC. Unfortunately, the failure rate and incidence of complications are much higher in pediatric patients due to the relatively small size of the vessels [2]. Experience is essential in order to successfully perform CVC in pediatric patients without causing complications. Other significant factors include the selection of an appropriate vein and a catheter of a suitable size. The IJV is relatively larger and easier to access than the SCV, and has been preferred for CVC in pediatric patients by many physicians. Yet, the IJV is easily collapsed by the ultrasound (US) probe or by needle pressure, making CVC challenging even though the vein may be well observed via US. In contrast, the SCV is not easily collapsed due to the presence of the clavicle and can be more appropriate when long-term catheter placement is required [3]. Although there are several studies regarding the size of the IJV in pediatric patients [1,2], few studies have been performed related to the size of the SCV. We attempted to find the most suitable variable, such as age, weight, or height, that could predict the size of the SCV in pediatric patients by measuring the size of the SCV in a group of these patients using ultrasound. Thirty-eight pediatric patients from 1 month to 10 years of age, who underwent an elective surgery were included in this study. Patients included in the study were scheduled for minor operations: inguinal hernia repair, hydrocelectomy, circumcision, and upper and lower extremity surgeries. Patients with congenital or cardiovascular diseases, and patients scheduled for cardiac, intracranial, or major vascular operations were excluded from the study. After induction of general anesthesia, patients were placed in a supine position with their arms positioned next to the trunk. The SCV was located with a linear probe using a method implemented previously [4]. Briefly, the longitudinalsection image of the SCV was obtained with an 18 MHz linear probe (LA435: 6–18 MHz, Esaote, Genova, Italy). Images were obtained by a single physican after acquiring a view in which the SCV seemed to have the largest diameter and the clavicle was positioned in the center of the image. Images were obtained three times on both sides at the end-expiratory phase of ventilation and were measured by two different study participants using image analysis software (MyLab TM Desk, Esaote, Genova, Italy). The internal diameter of the SCV was measured directly laterally and medially to the clavicle shadow, and defined as the average of these two values. The average of the values measured by the two different study participants was used as the SCV diameter in each pediatric patient. For statistical analysis, variables of regression modeling were selected using the stepwise selection method. R 3.1.0 (R Core Team, Vienna, Austria) was used as the statistical software, and variables were selected using the faraway and leaps packages. The leaps package automatically selects variables, and the Bayesian information criterion was used as the selection criterion. Sex, height, weight, and age were selected as independent variables

Short-term central venous catheter complications in patients with sickle cell disease who undergo apheresis

Patients with sickle cell disease (SCD) are prone to develop thrombosis and infection due to their inflammatory and immune deficiency state. These patients require red cell exchange therapy for treatment or prevention of hemoglobin S associated complications. Owing to vascular access problems, adult patients need central venous catheterization (CVC) for exchange procedures. Procedure related complications have been reported for long-term CVCs in pediatric patients. However, short-term CVC complications in adult patients are not clear. This report represents the results of documented complications of short-term CVCs in patients with SCD who undergo apheresis. A total of 142 non-tunneled catheters with average median diameter of 9F (range 8-16F) were implanted for apheresis. The catheters were mainly inserted through the right internal jugular vein (66.2%). Total days of catheter were 412. Results were reported as a complication rate and event according to 1,000 catheter days and compared to a control group including 37 healthy stem cell donors. In the patient group, 1 (1%) hematoma and 1 (1%) infection were observed for internal jugular vein catheterization (3.7 hemorrhages and 3.7 infections according to 1,000 catheter days), whereas four (8.9%) cases of thrombosis and 1 (2.2%) infection (27 and 6.9 according to 1,000 catheter days) developed in femoral vein. There was a significant difference in terms of thrombosis (P=0.009). In the control group, only individual developed thrombosis in internal jugular vein. Short-term CVC inserted through to the internal jugular vein seems to be safer than femoral vein in patients with SCD.