Ultrasound-guided percutaneous central venous catheterization in infants: Learning curve and related complications

Omid, Mohammad; Hadi Rafiei, Mohammad; Hosseinpour, Mehrdad; Memarzade, Mehrdad; Riahinejad, Maryam

Ultrasound-guided percutaneous central venous catheterization in infants: Learning curve and related complications

Authors

¹ Department of Pediatric Surgery, Imam Hosein Pediatric Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

² Department of Radiology, Imam Hosein Pediatric Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: This study was performed to evaluate the learning curve and related complications of ultrasound (US) guided central venous catheter (CVC) insertion in infants.
Materials and Methods: This study was performed in Imam Hosein Hospital of Isfahan from September 2014 to March 2015. Participants were infants consecutively candidate for CVC insertion. Three steps were designed to complement the learning. For each step of learning, 20 patients were considered and for every patient one CVC was inserted: (1) In the first step, venous puncture and guide wire passage was performed by an experienced radiologist and the surgeon was taught how to do it, then CVC was placed by the surgeon. (2) In the second step, venous puncture and guide-wire passage was performed by the surgeon under the supervision of the same radiologist, and then CVC was placed by the surgeon. (3) In the third step, US-guided CVC insertion was performed by the surgeon completely, and the radiologist came to the operating room only if it was necessary. In each of these steps, the time spent of the US probe on the skin until the guide wire passage into the vein was recorded for every patient. All perioperative complications were recorded.
Results: The mean point for the time spent of the US probe on the skin until the guide wire passage into the vein was 84.9 ± 13.6, 119.1 ± 15.2, and 90.3 ± 11.2 s in the step 1, 2 and 3, respectively (P = 0.04). There was no significant difference between the frequencies of complications among tree steps.
Conclusion: US-guided percutaneous CVC insertion is a safe and reliable method which can be easily and rapidly learned.

Keywords

References

1.	Fratino G, Molinari AC, Parodi S, Longo S, Saracco P, Castagnola E, et al. Central venous catheter-related complications in children with oncological/hematological diseases: An observational study of 418 devices. Ann Oncol 2005;16:648-54.
2.	Napalkov P, Felici DM, Chu LK, Jacobs JR, Begelman SM. Incidence of catheter-related complications in patients with central venous or hemodialysis catheters: A health care claims database analysis. BMC Cardiovasc Disord 2013 16;13:86.
3.	Feller-Kopman D. Ultrasound-guided internal jugular access: A proposed standardized approach and implications for training and practice. Chest 2007;132:302-9.
4.	Janik JE, Conlon SJ, Janik JS. Percutaneous central access in patients younger than 5 years: Size does matter. J Pediatr Surg 2004;39:1252-6.
5.	Broviac JW, Cole JJ, Scribner BH. A silicone rubber atrial catheter for prolonged parenteral alimentation. Surg Gynecol Obstet 1973;136:602-6.
6.	Heimbach DM, Ivey TD. Technique for placement of a permanent home hyperalimentation catheter. Surg Gynecol Obstet 1976;143:634-6.
7.	Ogata ES, Schulman S, Raffensperger J, Luck S, Rusnak M. Caval catheterization in the intensive care nursery: A useful means for providing parenteral nutrition to the extremely low birth-weight infant. J Pediatr Surg 1984;19:258-62.
8.	Male C, Julian JA, Massicotte P, Gent M, Mitchell L, PROTEKT Study Group. Significant association with location of central venous line placement and risk of venous thrombosis in children. Thromb Haemost 2005;94:516-21.
9.	Arul GS, Lewis N, Bromley P, Bennett J. Ultrasound-guided percutaneous insertion of Hickman lines in children. Prospective study of 500 consecutive procedures. J Pediatr Surg 2009;44:1371-6.
10.	Seldinger SI. Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta radiol 1953;39:368-76.
11.	Vegunta RK. Vascular access. In: Holcomb III GW, Murphy JP, Ostlie DJ, editors. Ashcraft's Pediatric Surgery, 6^th ed. London: Elsevier Health Sciences; 2014. p. 118-9.
12.	Zeller KA, Petty JK. Vascular access procedures. In: Ziegler MM, Azizkhan RG, von Allmen D, Weber TR, editors. Operative Pediatric Surgery, 2^nd ed. New York: McGraw Hill Education; 2014. p. 140-5.
13.	Alderson PJ, Burrows FA, Stemp LI, Holtby HM. Use of ultrasound to evaluate internal jugular vein anatomy and to facilitate central venous cannulation in paediatric patients. Br J Anaesth 1993;70:145-8.
14.	McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med 2003 20;348:1123-33.
15.	Dodge KL, Lynch CA, Moore CL, Biroscak BJ, Evans LV. Use of ultrasound guidance improves central venous catheter insertion success rates among junior residents. J Ultrasound Med 2012;31:1519-26.
16.	Lamperti M, Bodenham AR, Pittiruti M, Blaivas M, Augoustides JG, Elbarbary M, et al. International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Med 2012;38:1105-17.
17.	Leyvi G, Taylor DG, Reith E, Wasnick JD. Utility of ultrasound-guided central venous cannulation in pediatric surgical patients: A clinical series. Paediatr Anaesth 2005;15:953-8.
18.	Gebauer B, Teichgräber UM, Werk M, Beck A, Wagner HJ. Sonographically guided venous puncture and fluoroscopically guided placement of tunneled, large-bore central venous catheters for bone marrow transplantation-high success rates and low complication rates. Support Care Cancer 2008;16:897-904.
19.	Koroglu M, Demir M, Koroglu BK, Sezer MT, Akhan O, Yildiz H, et al. Percutaneous placement of central venous catheters: Comparing the anatomical landmark method with the radiologically guided technique for central venous catheterization through the internal jugular vein in emergent hemodialysis patients. Acta Radiol 2006;47:43-7.
20.	National Institute for Clinical Excellence [Internet]. Guidance on the Use of Ultrasound Locating Devices for Placing Central Venous Catheters. Technology Appraisal Guidance No. 49. c2002-[cited 2002 september]. Available from: https://www.nice.org.uk/guidance/ta49
21.	Nguyen BV, Prat G, Vincent JL, Nowak E, Bizien N, Tonnelier JM, et al. Determination of the learning curve for ultrasound-guided jugular central venous catheter placement. Intensive Care Med 2014;40:66-73.
22.	Slama M, Novara A, Safavian A, Ossart M, Safar M, Fagon JY. Improvement of internal jugular vein cannulation using an ultrasound-guided technique. Intensive Care Med 1997;23:916-9.
23.	Basford TJ, Poenaru D, Silva M. Comparison of delayed complications of central venous catheters placed surgically or radiologically in pediatric oncology patients. J Pediatr Surg 2003;38:788-92.
24.	Skladal D, Horak E, Maurer K, Simma B. Complications of percutaneous insertion of Hickman catheters in children. J Pediatr Surg 1999;34:1510-3.
25.	Grebenik CR, Boyce A, Sinclair ME, Evans RD, Mason DG, Martin B. NICE guidelines for central venous catheterization in children. Is the evidence base sufficient? Br J Anaesth 2004;92:827-30.
26.	Froehlich CD, Rigby MR, Rosenberg ES, Li R, Roerig PL, Easley KA, et al. Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit. Crit Care Med 2009;37:1090-6.

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