Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.
Department of Surgery, Division of the Gastrointestinal, Endocrine and Pediatric Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan.
J Vasc Access. 2022 Sep;23(5):698-705. doi: 10.1177/11297298211008084. Epub 2021 Apr 7.
Tunneled central venous catheter (tCVC) placement plays an important role in the management of pediatric patients. We adopted a real-time ultrasound (US)-guided supraclavicular approach to brachiocephalic vein cannulation. We evaluated the outcomes of tCVC placement via a US-guided supraclavicular approach.
A retrospective study was performed for patients who underwent US-guided central venous catheterization of the internal jugular vein (IJV group) and brachiocephalic vein (BCV group) in our institution. The background information and outcomes were reviewed using medical records.
We evaluated 85 tCVC placements (IJV group: = 59, BCV group: = 26). Postoperative complications were recognized in 19 patients in the IJV group (catheter-related bloodstream infection (CRBSI), = 14 (1.53 per 1000 catheter days); occlusion, = 1 (1.7%, 1.09 per 1000 catheter days); accidental removal, = 3 (5.2%, 0.33 per 1000 catheter days); and other, = 1 (1.7%, 1.09 per 1000 catheter days)) and five patients in the BCV group (CRBSI, = 2 (0.33 per 1000 catheter days); catheter damage, = 1 (3.8%, 1.67 per 1000 catheter days); and accidental removal, = 2 (7.7%, 0.33 per 1000 catheter days)). In the BCV group, despite that, the incidence of postoperative complications was lower ( = 0.205) and the period of placement was significantly longer in comparison to the IJV group ( = 0.024).
US-guided placement of tunneled CVC though the BCV results in a low rate of postoperative complications despite longer CVC indwelling times compared to IJV insertion. Our results suggest that BCV insertion of tunneled CVC in children may offer advantages in terms of device performance and patient safety.
经皮隧道式中心静脉导管（tCVC）的置入在儿科患者的治疗中起着重要作用。我们采用实时超声（US）引导锁骨下方法进行头臂静脉置管。我们评估了超声引导锁骨下途径 tCVC 置入的结果。
对在我院行超声引导下中心静脉置管的颈内静脉（IJV 组）和头臂静脉（BCV 组）患者进行回顾性研究。使用病历回顾患者的背景信息和结果。
我们评估了 85 例 tCVC 置管（IJV 组：n=59，BCV 组：n=26）。IJV 组术后并发症有 19 例（导管相关血流感染（CRBSI），n=14（1.53 例/1000 导管日）；阻塞，n=1（1.7%，1.09 例/1000 导管日）；意外拔除，n=3（5.2%，0.33 例/1000 导管日）；其他，n=1（1.7%，1.09 例/1000 导管日）），BCV 组有 5 例（CRBSI，n=2（0.33 例/1000 导管日）；导管损坏，n=1（3.8%，1.67 例/1000 导管日）；意外拔除，n=2（7.7%，0.33 例/1000 导管日））。BCV 组尽管术后并发症发生率较低（n=0.205），但置管时间明显长于 IJV 组（n=0.024）。
与颈内静脉置管相比，超声引导下经锁骨下隧道式 CVC 置管的术后并发症发生率较低，尽管 CVC 留置时间较长。我们的结果表明，在儿童中，经锁骨下隧道式 CVC 置管可能在器械性能和患者安全方面具有优势。
