Lower Extremity Vascular Access in Neonates and Infants: A Single Institutional Experience.
OBJECTIVE
To demonstrate feasibility and evaluate outcomes of direct-stick saphenous and single-incision tunneled femoral noncuffed central venous catheters (CVCs) placed in a large series of neonates and infants at a single institution.


METHODS
A retrospective review was performed for all neonates and infants receiving a lower extremity CVC by interventional radiology between 2007 and 2012. Technical success, mechanical and infectious complications, and catheter outcomes were recorded.


RESULTS
There were 271 primary insertions performed in 243 children by interventional radiologists in the interventional radiology suite or at the bedside. CVCs were placed via the femoral vein with single-incision technique (84.9%) or the saphenous vein via a direct-stick technique (15.1%), with a technical success rate of 100%. The total number of catheter-days was 7,917 days (median, 19 d; range, 0-220 d). The number of primary catheter-days was 5,333 days (median, 15 d; range, 0-123.0 d), and salvage procedures prolonged catheter life by 2,584 days (median, 15 d; range, 1.0-101.0 d). The mechanical and adjusted infectious complication rates were 1.67 and 0.44 per 100 catheter-days.


CONCLUSIONS
Image-guided placement of saphenous or tunneled femoral catheters using a single incision is a safe and feasible method for vascular access in neonates and infants.
Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104. Electronic address: gaballahm@email.chop.edu.
Marian
M
Gaballah
Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104.
Ganesh
G
Krishnamurthy
Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104.
Jeffrey I
JI
Berman
Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104.
J Christopher
JC
Edgar
Department of Radiology, Yale New Haven Health, Bridgeport Hospital, Bridgeport, Connecticut.
Melkamu
M
Adeb
Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104.
Marc S
MS
Keller
Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104.
Adeka
A
McIntosh
Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104.
Maricarmen
M
Nazario
Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104.
Anne Marie
AM
Cahill
D055499:Catheter-Related Infections / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005268:Femoral Vein / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D035002:Lower Extremity / Q000098:blood supply / Q000601:surgery; D015143:Philadelphia / Q000453:epidemiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D015641:Radiography, Interventional / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012501:Saphenous Vein / Q000601:surgery*; D016896:Treatment Outcome