Supraclavicular catheterization of the brachiocephalic vein: a way to prevent or reduce catheter maintenance-related complications in children

• Published in: European journal of pediatrics Vol. 177; no. 3; pp. 451 - 459
• Main Authors: Habas, Flora, Baleine, Julien, Milési, Christophe, Combes, Clémentine, Didelot, Marie-Noëlle, Romano-Bertrand, Sara, Grau, Delphine, Parer, Sylvie, Baud, Catherine, Cambonie, Gilles
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-03-2018; Springer Nature B.V; Springer Verlag [1975-....]
• Subjects: Adolescent; Brachiocephalic Veins; Catheter-Related Infections - diagnosis; Catheter-Related Infections - epidemiology; Catheter-Related Infections - etiology; Catheter-Related Infections - prevention & control; Catheterization; Catheterization, Central Venous - methods; Catheters; Child; Child, Preschool; Children; Clavicle; Female; Femur; Human health and pathology; Humans; Incidence; Infant; Infants; Intubation; Life Sciences; Logistic Models; Male; Medicine; Medicine & Public Health; Original Article; Pediatrics; Retrospective Studies; Thrombosis; Treatment Outcome; Ultrasonic imaging; Ultrasonography, Interventional; Ultrasound; Veins & arteries; Venous Thrombosis - diagnosis; Venous Thrombosis - epidemiology; Venous Thrombosis - etiology; Venous Thrombosis - prevention & control; Catheter-associated bloodstream infection; Children; Ultrasound guidance; Catheter-associated deep-vein thrombosis; Supraclavicular approach; Brachiocephalic vein
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s00431-017-3082-x

Placement of a central venous catheter (CVC) in the brachiocephalic vein (BCV) via the ultrasound (US)-guided supraclavicular approach was recently described in children. We aimed to determine the CVC maintenance-related complications at this site compared to the others (i.e., the femoral, the subclavian, and the jugular). We performed a retrospective data collection of prospectively registered data on CVC in young children hospitalized in a pediatric intensive care unit (PICU) during a 4-year period (May 2011 to May 2015). The primary outcome was a composite of central line-associated bloodstream infection (CLABSI) and deep-vein thrombosis (CLAT) according to the CVC site. Two hundred and twenty-five children, with respective age and weight of 7.1 (1.3–40.1) months and 7.7 (3.6–16) kg, required 257 CVCs, including 147 (57.2%) inserted in the BCV. The risk of the primary outcome was lower in the BCV than in the other sites (5.4 vs 16.4%; OR: 0.29; 95% CI: 0.12–0.70;
p
 = 0.006). CLABSI incidence density rate (2.8 vs 8.96 per 1000 catheter days,
p
 < 0.001) and CLAT incidence rate (2.7 vs 10%,
p
 = 0.016) were also lower at this site.
Conclusion
: BCV catheterization via the US-guided supraclavicular approach may decrease CVC maintenance-related complications in children hospitalized in a PICU.
What is Known:
• Placement of a central venous catheter (CVC) in children is associated with mechanical risks during insertion, and with infectious and thrombotic complications during its maintenance.
• Ultrasound (US)-guided supraclavicular catheterization of the brachiocephalic vein (BCV) is feasible in infants and children.
What is New:
• This observational study suggested that BCV catheterization
via
the US-guided supraclavicular approach was associated with a lower risk of CVC insertion and maintenance-related complications, compared with the other catheterization sites.