Uses and complications of central venous catheters inserted in a pediatric emergency department.
OBJECTIVE
To describe the incidence, indications, insertion sites, duration, and complications of central venous catheter (CVC) insertion in patients in a pediatric emergency department (ED).


METHODS



METHODS
Retrospective chart review.


METHODS
ED of an urban pediatric teaching hospital.


METHODS
Patients who had a CVC inserted in the ED from January 1992 to July 1997.


RESULTS
During the 5.5-year study period, 121 patients were identified. Indications for insertion were cardiac/respiratory arrest in 20 patients (17%), lack of peripheral vascular access in 78 (64%), and inadequate peripheral vascular access in 23 (19%). Presenting diagnoses included cardiac/respiratory arrest (20), dehydration (19), lower respiratory tract disease (15), seizure (15), sepsis (13), trauma (10), and other (29). Prior to the CVC insertion, 80 (66%) patients had no venous access, 28 (23%) had a peripheral intravenous catheter, and 13 (11%) had an intraosseous needle. One hundred one (83%) CVCs were inserted into the femoral vein, 12 (10%) into the subclavian, 7 (6%) into the internal jugular, and 1 (1%) into an axillary vein. There were four reported complications requiring the CVC to be removed, and all occurred with femoral line placement. There were no long-term sequelae or life-threatening or limb-threatening complications (95% CI = 0-2.5%).


CONCLUSIONS
Central venous catheterization, particularly using the femoral approach, appears to a safe method of obtaining central venous access in the critically ill infant, child, or young adult.
Chiang
V W
VW
Division of Emergency Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. chiang@a1.tch.harvard.edu
Baskin
M N
MN
D000293:Adolescent; D000328:Adult; D001900:Boston; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy; D004636:Emergency Service, Hospital; D005268:Femoral Vein; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010372:Pediatrics; D012151:Resuscitation / Q000379:methods; D012189:Retrospective Studies