Gaballah Marian, Krishnamurthy Ganesh, Keller Marc S, McIntosh Adeka, Cahill Anne Marie
Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA,
Pediatr Radiol. 2014 Aug;44(8):1004-10. doi: 10.1007/s00247-014-2917-0. Epub 2014 Mar 11.
Central venous access is indispensable in caring for children with infections, malignancies and chronic illnesses, and image-guided placement of central venous access devices (CVAD) is increasingly used. A single-incision technique for placement of tunneled central venous access devices at the internal jugular vein has been described; however the technique has not been described exclusively in children.
To describe our initial experience using the single-incision technique for tunneled central venous access at the internal jugular vein in children.
We conducted a retrospective review of the interventional radiology database and electronic medical records of 15 children who received a tunneled central venous access device (CVAD) using a single incision between 2010 and 2012. Patients included eight boys and seven girls with an average age of 11 years (median 13.3 years, range 1-18.7 years) and average weight of 44.2 kg (median 38.3 kg, range 9.6-99.0 kg).
A total of 17 primary insertions were performed. Technical success was 100%. Total catheter life consisted of 1,416 catheter-days (mean 83.3 days, range 8-502 days). There were no procedure-related or early complications. Seven late complications requiring intervention occurred in three catheters. Total mechanical and infectious complications occurred at rates of 0.28 and 0.21 per 100 catheter-days, respectively. The adjusted rate for infectious complications was 0.14 per 100 catheter-days. Medical salvage procedures (83%) and interventional radiology salvage procedures (17%) prolonged catheter life by an average of 94.5 days (range 10-329 days).
This study demonstrates safe use and technical feasibility of the image-guided single-incision technique for central venous access in children, particularly in children in whom the conventional technique is less desirable.
中心静脉通路对于感染、恶性肿瘤及慢性病患儿的护理至关重要，影像引导下中心静脉通路装置（CVAD）的置入应用日益广泛。一种在内颈静脉置入带隧道中心静脉通路装置的单切口技术已被描述；然而该技术尚未专门针对儿童进行描述。
描述我们使用单切口技术为儿童在内颈静脉置入带隧道中心静脉通路的初步经验。
我们对2010年至2012年间15例接受单切口带隧道中心静脉通路装置（CVAD）置入的儿童的介入放射学数据库及电子病历进行了回顾性分析。患者包括8名男孩和7名女孩，平均年龄11岁（中位数13.3岁，范围1 - 18.7岁），平均体重44.2千克（中位数38.3千克，范围9.6 - 99.0千克）。
共进行了17次初次置入。技术成功率为100%。导管总使用时长为1416导管日（平均83.3天，范围8 - 502天）。无与操作相关的并发症或早期并发症。3根导管出现7例需要干预的晚期并发症。机械和感染并发症的总发生率分别为每100导管日0.28例和0.21例。感染并发症的校正发生率为每100导管日0.14例。医疗挽救措施（83%）和介入放射学挽救措施（17%）使导管使用时长平均延长94.5天（范围10 - 329天）。
本研究表明影像引导下单切口技术用于儿童中心静脉通路是安全的且技术可行，尤其适用于传统技术不太适用的儿童。
