title: Subclavian vein catheterization in critically ill children: analysis of 322 cannulations.
abstract: Complications in 322 percutaneous subclavian vein catheters placed in 272 children by the infraclavicular approach were investigated prospectively. Ages ranged from 4 days to 15 years. Incidents during catheter introduction occurred in 13 cases, and were more common when insertion was on the right side (p less than 0.01). Nine (2.8%) required urgent treatment: (6 pneumothorax, 1 hydrothorax, and 2 hemothorax). Anomalous lodging of the catheter tip was more common when insertion was on the right side (p less than 0.05). Complications during catheter maintenance were 3 venous thromboses, 3 catheter obstructions, and 7 migrations out of position. There was no significant difference in complications related to age. Catheter cultures were positive in 33 (17%) of 190 catheters cultured (27 through colonization and 6 through catheter-related sepsis). Staph. epidermidis was the organism most frequently isolated (19 cases; 58%). Catheterization time of more than 5 days and catheter-related sepsis were statistically associated (p less than 0.05). Staph. epidermidis isolation and duration of cannula use were statistically related (p less than 0.01). No catheter-related deaths occurred. We conclude that subclavian vein catheterization is a simple and useful procedure that entails relatively few serious complications when performed by experienced pediatricians.
authors.affiliation: Pediatric Intensive Care Unit, Niño Jesús Hospital, Autónoma University of Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Casado-Flores
authors.forename: A
authors.initials: A
authors.lastname: Valdivielso-Serna
authors.forename: L
authors.initials: L
authors.lastname: Pérez-Jurado
authors.forename: J
authors.initials: J
authors.lastname: Pozo-Román
authors.forename: M
authors.initials: M
authors.lastname: Monleón-Luque
authors.forename: J
authors.initials: J
authors.lastname: García-Pérez
authors.forename: A
authors.initials: A
authors.lastname: Ruiz-Beltran
authors.forename: M A
authors.initials: MA
authors.lastname: García-Teresa
mesh_terms: D000293:Adolescent; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D010372:Pediatrics / Q000379:methods / Q000592:standards*; D011030:Pneumothorax / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D013350:Subclavian Vein; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology