Mechanical complications during central venous cannulations in pediatric patients.
OBJECTIVE
Identification of early mechanical complications (EMC) of central venous catheterizations (CVC) in pediatric patients and determination of EMC risk factors.


METHODS
Prospective observational study.


METHODS
Pediatric intensive-care unit in a university hospital.


METHODS
Eight-hundred and twenty-five CVC were performed in 546 patients. Age, weight, gender, mechanical ventilation, analgesia, resident CVC failure, CVC indication, admission diagnosis, emergency or scheduled procedure, type of catheter (diameter, lumen number), catheter final location, number of attempts, and EMC were recorded. Risk factors for EMC were determined by multivariate analysis.


RESULTS
Median patient age was 22.0 months (0-216 months). CVC was an emergency procedure in 421 (51%) cases, scheduled in 336 (40.7%), and guide-wire exchanged in 68 (8.2%). There were 293 (35.5%) internal jugular, 116 (14.1%) subclavian, and 416 (50.4%) femoral catheters. CVC was performed by staff physicians in 35.8% cases, supervised residents in 43.4%, and staff after resident failure in 20.8%. 151 EMC occurred in 144 CVC (17.5%). The most common EMC were arterial puncture (n = 60; 7.2%), catheter malposition (n = 39; 4.7%), arrhythmias (n = 19; 2.3%), and hematoma (n = 12; 1.4%). Resident failure to perform CVC (OR 2.53; CI 95% 1.53-4.16), high venous access (subclavian or jugular) (OR 1.91; CI 95% 1.26-2.88), and number of attempts (OR 1.10; CI 95% 1.03-1.17) were independently associated with EMC.


CONCLUSIONS
EMC of CVC were common in a teaching university hospital, but severe complications were very uncommon. Resident failure to perform CVC, high venous access, and number of attempts were independent risk factors for EMC of CVC.
Rey
Corsino
C
Paediatric Intensive Care Unit, Department of Paediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Celestino Villamil s/n 33006, Asturias, Oviedo, Spain. corsino.rey@sespa.princast.es
Alvarez
Francisco
F
De La Rua
Victoria
V
Medina
Alberto
A
Concha
Andrés
A
Díaz
Juan José
JJ
Menéndez
Sergio
S
Los Arcos
Marta
M
Mayordomo-Colunga
Juan
J
D000293:Adolescent; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D015999:Multivariate Analysis; D019990:Perioperative Care; D011446:Prospective Studies; D012307:Risk Factors