Central venous catheters in pediatric patients--subclavian venous approach as the first choice.
BACKGROUND
It is critical to establish a safe and functional i.v. access in severely sick patients. We evaluated the frequency of application and complications of central venous catheters in a pediatric intensive care unit.


METHODS
Pediatric patients in whom central venous catheters were inserted between March 1997 and May 1999 in the Pediatric Emergency Room and Intensive Care Unit were enrolled in this study. Patients were evaluated with respect to age, sex, weight, central venous catheter indication, site, duration of catheter stay and complications.


RESULTS
During the study period a total of 156 central venous catheters were successfully inserted into 146 patients. Of the 156 central venous catheter attempts, 148 (94.9%) were placed into the subclavian vein, six were inserted into the femoral vein, and two into the jugular vein. In 156 attempts, arterial injuries occurred in 20 cases (12.8%). Pneumothorax developed in two patients on mechanical ventilation. Three catheters had to be removed due to catheter related infections. The mortality rate was 0%.


CONCLUSIONS
We concluded that subclavian central venous catheterization is a safe procedure with minimal complications in pediatric patients. Arterial injury was the most frequent complication. In experienced hands, the success rate was 100%. Subclavian central venous catheter insertion may be considered as the first approach in critically ill patients.
Citak
Agop
A
Pediatric Emergency Department, Institute of Child Health, University of Istanbul, Istanbul, Turkey. agopcitak@hotmail.com
Karaböcüoğlu
Metin
M
Uçsel
Raif
R
Uzel
Nedret
N
D000293:Adolescent; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D013350:Subclavian Vein