title: Shifting from open surgical cut down to ultrasound-guided percutaneous central venous catheterization in children: learning curve and related complications.
abstract: OBJECTIVE
  Tunneled indwelling central venous catheters (CVC) are essential in the management of children with cancer, hematological, nephrological disorders and for parenteral nutrition. The aim of this study is to present the experience of a single center of the transition from traditional open surgical cut down procedure (OSC) to ultrasound (US)-guided percutaneous CVC insertion, focusing on learning curve and related complications.
  
  
  METHODS
  All CVCs inserted between April 2008 and November 2009 in children at the Gaslini Children Hospital were revised, and data on methods of cannulation, intraoperative and device-related complications and re-intervention were recorded.
  
  
  RESULTS
  194 CVCs were positioned in 188 patients. 128 out of 194 CVCs were positioned through an OSC technique, whereas the remaining 66 CVCs were inserted percutaneously with US guidance. Of the 27 recorded complications, 15 were mechanical events, 7 cases developed infection, whereas the remaining 5 (2.6%) were classified as intraoperative complications. A second surgical procedure was described in 23 (11.8%) cases.
  
  
  CONCLUSIONS
  Shifting from OSC to US-guided percutaneous CVC insertion inevitably involves a challenging learning curve which is generally associated with high complication rates. Complications progressively decrease once a good experience in US guidance and percutaneous technique has been obtained.
authors.affiliation: Paediatric Surgery Department, G. Gaslini Children Hospital, Genoa, Italy. stefano.avanzini@libero.it
authors.forename: S
authors.initials: S
authors.lastname: Avanzini
authors.forename: E
authors.initials: E
authors.lastname: Guida
authors.forename: M
authors.initials: M
authors.lastname: Conte
authors.forename: F
authors.initials: F
authors.lastname: Faranda
authors.forename: P
authors.initials: P
authors.lastname: Buffa
authors.forename: C
authors.initials: C
authors.lastname: Granata
authors.forename: E
authors.initials: E
authors.lastname: Castagnola
authors.forename: G
authors.initials: G
authors.lastname: Fratino
authors.forename: L
authors.initials: L
authors.lastname: Mameli
authors.forename: A
authors.initials: A
authors.lastname: Michelazzi
authors.forename: A
authors.initials: A
authors.lastname: Pini-Prato
authors.forename: G
authors.initials: G
authors.lastname: Mattioli
authors.forename: A C
authors.initials: AC
authors.lastname: Molinari
authors.forename: E
authors.initials: E
authors.lastname: Lanino
authors.forename: V
authors.initials: V
authors.lastname: Jasonni
mesh_terms: D000293:Adolescent; D002405:Catheterization, Central Venous / Q000379:methods*; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014656:Vascular Surgical Procedures / Q000193:education* / Q000379:methods*