title: A review of 5434 percutaneous pediatric central venous catheters inserted by anesthesiologists.
abstract: OBJECTIVE
  To review the results of an anesthesiologist led pediatric percutaneous central venous access service.
  
  
  METHODS
  Prospective data on percutaneous pediatric central venous catheter (CVC) insertions were collected over 22 years. Data included age, gender, weight, previous central CVCs, venous thromboses, investigations for great vein patency, type of CVC, external diameter, previous CVC insertions, intended use, operator identity, and the vein into which the CVC was inserted. The default technique was internal jugular vein cannulation using landmark technique (LT). Complication was defined as the following: failure to cannulate any vein, hemothorax, pneumothorax, right atrial perforation, extravenous wire positioning or CVC position and whether the patient was taken back to theater for CVC repositioning.
  
  
  RESULTS
  Five thousand four hundred and thirty-four percutaneous CVC insertion procedures were performed on 3954 patients. One-third involved children <1 year of age (n = 1823: 34%). Five thousand one hundred and twenty-five CVCs (95.3%) were inserted into internal jugular veins. The majority were tunneled CVCs (n = 5190: 96.2%). The perioperative complication rate was 1.3%. Successful cannulation occurred in 99.5% of patients. Failure was more likely in children <3 kg, during large bore hemodialysis CVC insertions and during the first 4 years of the service - the latter suggesting a learning curve. Ninety-nine percent of CVCs were inserted using LTs.
  
  
  CONCLUSIONS
  This study demonstrates a high success rate and low complication rate during pediatric percutaneous internal jugular vein CVC insertions by trained anesthesiologists using LTs. Smaller children, hemodialysis CVCs, and the team's learning curve were identified as risk factors for insertion failure.
authors: Department of Anesthesiology and Intensive Care, Robert Debré University Hospital, AP-HP, Paris, France; Université René Diderot (Paris VII), PRES Sorbonne Paris Cite, Paris, France.
authors: Serge
authors: S
authors: Malbezin
authors: Tobias
authors: T
authors: Gauss
authors: Ian
authors: I
authors: Smith
authors: Beatrice
authors: B
authors: Bruneau
authors: Nyamjargal
authors: N
authors: Mangalsuren
authors: Thierno
authors: T
authors: Diallo
authors: Alia
authors: A
authors: Skhiri
authors: Yves
authors: Y
authors: Nivoche
authors: Souhayl
authors: S
authors: Dahmani
authors: Christopher
authors: C
authors: Brasher
mesh_terms: D059925:Anatomic Landmarks; D000776:Anesthesiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D062905:Central Venous Catheters / Q000009:adverse effects; D002675:Child, Preschool; D002983:Clinical Competence; D003625:Data Collection; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D059032:Learning Curve; D008297:Male; D010288:Parenteral Nutrition / Q000379:methods; D010820:Physicians; D016683:Supine Position; D017211:Treatment Failure; D016896:Treatment Outcome; D062666:Vascular Access Devices
keywords: anesthesiologist; central venous access; central venous catheterization; complications; jugular vein; pediatrics; percutaneous