title: Effectiveness and complications of ultrasound-guided subclavian vein cannulation in children and neonates.
abstract: BACKGROUND
  The ultrasound (US)-guided supraclavicular approach to subclavian vein (Sup-SCV) catheterisation in children has recently been described and evaluated in a small cohort. The aim of this study was to assess this technique in a large paediatric cohort including neonates.
  
  
  METHODS
  We conducted a prospective observational study between November 2010 and December 2013 which included 615 children divided into two groups according to their weight: Group 1≤5kg (n=124), Group 2>5kg (n=491). All procedures were performed under general anaesthesia by an anaesthesiologist or a supervised resident. The success rates of catheter insertion, the number of punctures required, the procedure time, and the complication rates were analysed.
  
  
  RESULTS
  Sup-SCV catheterisation was successful in 98% of the cases and was higher in Group 2 than in Group 1 (99.4% versus 92.7%, P<0.001). The success rate after the first attempt was higher and the incidence of multiple attempts (≥3 punctures) was lower in Group 2 than in Group 1 (84.2% versus 64.5%, P<0.001 and 4.5% versus 19.4%, P<0.001). The success rate was similar between right and left cannulations (P=0.404), and according to physician experience (P=1.000). Procedure time was fast in both groups with a median time for all procedures of 40 seconds [30-90]. Among the procedures recorded, only five arterial punctures and no cases of pneumothorax were observed.
  
  
  CONCLUSIONS
  US-guided Sup-SCV catheterisation appears to be fast and safe in children and neonates, even if it remains a little more difficult to achieve in lower-weight patients.
authors.affiliation: Service d'anesthésie-réanimation 2, CHU de Rennes, 35203 Rennes, France; Université de Rennes 1, 35000 Rennes, France; UMR Inserm 1099, LTSI, université de Rennes 1, 35043 Rennes, France. Electronic address: nicolas.nardi@chu-rennes.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Nardi
authors.affiliation: Service d'anesthésie-réanimation 2, CHU de Rennes, 35203 Rennes, France; Université de Rennes 1, 35000 Rennes, France; UMR Inserm 1099, LTSI, université de Rennes 1, 35043 Rennes, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Wodey
authors.affiliation: Université de Rennes 1, 35000 Rennes, France; Service de pharmacologie, centre d'investigation clinique, CHU de Rennes, 35000 Rennes, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Laviolle
authors.affiliation: Service d'anesthésie-réanimation 2, CHU de Rennes, 35203 Rennes, France.
authors.forename: François
authors.initials: F
authors.lastname: De La Brière
authors.affiliation: Service d'anesthésie-réanimation 2, CHU de Rennes, 35203 Rennes, France.
authors.forename: Séverine
authors.initials: S
authors.lastname: Delahaye
authors.affiliation: Service d'anesthésie-réanimation 2, CHU de Rennes, 35203 Rennes, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Engrand
authors.affiliation: Service d'anesthésie-réanimation 2, CHU de Rennes, 35203 Rennes, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Gauvrit
authors.affiliation: Service d'anesthésie-réanimation 2, CHU de Rennes, 35203 Rennes, France.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Dessard
authors.affiliation: Service d'anesthésie-réanimation 2, CHU de Rennes, 35203 Rennes, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Defontaine
authors.affiliation: Service d'anesthésie-réanimation 2, CHU de Rennes, 35203 Rennes, France; Université de Rennes 1, 35000 Rennes, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Ecoffey
mesh_terms: D000768:Anesthesia, General; D001158:Arteries / Q000293:injuries; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D013350:Subclavian Vein / Q000000981:diagnostic imaging*; D017211:Treatment Failure; D018084:Ultrasonography, Interventional
keywords: Brachiocephalic; Catheterization; Central venous; Children; Subclavian; Ultrasonography