title: Ultrasound-guided left brachiocephalic vein cannulation in children with underlying bleeding disorders: a retrospective analysis.
abstract: OBJECTIVE
  To evaluate the safety and effectiveness of ultrasound-guided left brachiocephalic vein cannulation in infants and children with underlying bleeding conditions.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  PICU of a tertiary pediatric hospital.
  
  
  METHODS
  Thirty-four patients requiring central venous catheterization from January 2011 to January 2012.
  
  
  METHODS
  None.
  
  
  RESULTS
  Two pediatric intensivists, experienced in ultrasound-guided vessel cannulation, performed the ultrasound catheterization of the left brachiocephalic vein. Ultrasound equipment consisted of a standard ultrasound monitor with a linear 6-13 MHz probe. The ultrasound monitor was set on a resolution with a depth of 1.8 cm for infants and 2.2 cm for children. The "in-plane" technique was used for all patients. Thirty-four catheterizations were performed. Patient median age was 12.5 months (5.75-63.5 mo) and median weight was 9.25 kg (7-16.25 kg). The population of infants and children analyzed was composed of 25 patients with hematologic disorder (73%) treated with hematopoietic stem cell transplantation, five patients (15%) supported with extracorporeal membrane oxygenation for viral pneumonias, and four patients (12%) with uremic hemolytic syndrome. A 4F catheter was used in 79% of cases. Left brachiocephalic vein cannulation was successful in all 34 patients. Median time needed for cannulation was 350 seconds (277.5-450 s). The overall complication rate was 9% (3 of 34) and consisted of difficulty in advancing the guidewire after having pierced the vein. The time required for catheter positioning and complications was not associated with both lower body weight and body surface area of the patients (p > 0.05). Mean central venous catheter duration was 32 ± 4 days.
  
  
  CONCLUSIONS
  Data reported in this retrospective study confirm the safety and effectiveness of ultrasound-guided left brachiocephalic vein catheterization in infants and children with underlying bleeding disorders.
authors.affiliation: 1Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy. 2Pediatric Cardiac Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy. 3Emergency Care, Children's Hospital Bambino Gesù, IRCCS, Palidoro, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Di Nardo
authors.forename: Francesca
authors.initials: F
authors.lastname: Stoppa
authors.forename: Marco
authors.initials: M
authors.lastname: Marano
authors.forename: Zaccaria
authors.initials: Z
authors.lastname: Ricci
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Barbieri
authors.forename: Corrado
authors.initials: C
authors.lastname: Cecchetti
mesh_terms: D001778:Blood Coagulation Disorders / Q000000981:diagnostic imaging* / Q000601:surgery; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging* / Q000601:surgery; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000379:methods*