title: Real-time ultrasonography for placement of central venous catheters in children: A multi-institutional study.
abstract: Recommendations for the use of real-time ultrasonography for placement of central venous catheters in children are based on studies involving adults treated by nonsurgeons. Our purpose was to determine the frequency of use of real-time ultrasonography use by pediatric surgeons during central venous catheter placement, patient and procedure factors associated with real-time ultrasonography use, and adverse event rates.
  
  
  
  Using data gathered from 14 institutions, we performed a retrospective cohort study of patients <18 years old who underwent central venous catheter placement. Patient demographics and operative details were collected. We used a logistic regression model to evaluate factors associated with real-time ultrasonography use.
  
  
  
  Real-time ultrasonography was used in 33% of attempts (N = 1,146). The subclavian vein (64%) was accessed preferentially for first site insertion. Real-time ultrasonography was less likely to be used for subclavian vein (odds ratio = 0.002; P < .0001) and more likely to be used when coagulopathy (international normalized ratio >1.5) was present (odds ratio = 11.1; P = .03). The rate of mechanical complications was 3.5%. Real-time ultrasonography use was associated with greater procedural success rates on first-site attempt, but also with a greater risk of hemothorax.
  
  
  
  Pediatric surgeons access preferentially the subclavian vein for central venous access, yet are less likely to use real-time ultrasonography at this site. Real-time ultrasonography was superior to the landmark techniques for the first-site procedure success, yet was associated with greater rates of hemothorax. Prospective trials involving children treated by pediatric surgeons are needed to generate more definitive data.
authors.affiliation: Department of Pediatric Surgery, Arkansas Children's Hospital, Little Rock, AR. Electronic address: lgurien@gmail.com.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Gurien
authors.affiliation: Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Blakely
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Alabama, Birmingham, AL.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Russell
authors.affiliation: Department of Pediatric Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Streck
authors.affiliation: Department of Pediatric Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Vogel
authors.affiliation: Department of Pediatric Surgery, Albany Medical Center, Albany, NY.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Renaud
authors.affiliation: Department of Pediatric Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Kate B
authors.initials: KB
authors.lastname: Savoie
authors.affiliation: Department of Pediatric Surgery, Arkansas Children's Hospital, Little Rock, AR.
authors.forename: Melvin S
authors.initials: MS
authors.lastname: Dassinger
mesh_terms: D000367:Age Factors; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013350:Subclavian Vein; D018084:Ultrasonography, Interventional