Gurien Lori A, Blakely Martin L, Russell Robert T, Streck Christian J, Vogel Adam M, Renaud Elizabeth J, Savoie Kate B, Dassinger Melvin S
Department of Pediatric Surgery, Arkansas Children's Hospital, Little Rock, AR.
Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN.
Surgery. 2016 Dec;160(6):1605-1611. doi: 10.1016/j.surg.2016.05.019. Epub 2016 Jul 25.
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.
儿童中心静脉导管置管使用实时超声检查的建议是基于对非外科医生治疗的成人进行的研究。我们的目的是确定小儿外科医生在中心静脉导管置管期间使用实时超声检查的频率、与使用实时超声检查相关的患者和手术因素以及不良事件发生率。
利用从14家机构收集的数据，我们对18岁以下接受中心静脉导管置管的患者进行了一项回顾性队列研究。收集了患者的人口统计学资料和手术细节。我们使用逻辑回归模型来评估与使用实时超声检查相关的因素。
33%的置管尝试（n = 1146）使用了实时超声检查。锁骨下静脉（64%）优先用于首次置管部位。锁骨下静脉置管时使用实时超声检查的可能性较小（优势比 = 0.002；P <.0001），而存在凝血功能障碍（国际标准化比值>1.5）时使用实时超声检查的可能性较大（优势比 = 11.1；P =.03）。机械并发症发生率为3.5%。使用实时超声检查与首次置管尝试时更高的手术成功率相关，但也与更高的血胸风险相关。
小儿外科医生在中心静脉置管时优先选择锁骨下静脉，但在该部位使用实时超声检查的可能性较小。实时超声检查在首次置管手术成功率方面优于体表标志技术，但与更高的血胸发生率相关。需要进行涉及小儿外科医生治疗儿童的前瞻性试验以产生更明确的数据。
