Cardiac Intensive Care Unit, Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Neonatology, The Second People's Hospital of Kashi, Xinjiang, China.
J Cardiothorac Vasc Anesth. 2024 Jul;38(7):1477-1483. doi: 10.1053/j.jvca.2024.03.026. Epub 2024 Mar 24.
Central venous catheterization is used widely in critical pediatric patients. The authors sought to compare the success rate and safety of ultrasound-guided subclavian vein cannulation performed via infraclavicular and supraclavicular approaches.
The authors compared the success rate of the first puncture and other information for cannulation in the children with congenital heart disease requiring central venous catheterization who were assigned randomly to the supraclavicular approach group (group A) or infraclavicular approach group (group B).
Medical university hospital pediatric cardiac intensive care units.
Pediatric patients diagnosed with congenital heart disease in the preoperative period who were admitted to the cardiac intensive care unit and required subclavian vein catheterization.
Ultrasound-guided subclavian vein cannulation.
Sixty-seven children were included in the study, with 32 in group A and 35 in group B. Notably, there was a significant difference in the success rate of the first puncture between groups A and B (90.6% v 71.4, %, p = 0.047). Furthermore, the access time in group A was 11.8 seconds (3.2-95), which was significantly shorter than that in group B (16.0 [6.5-227] seconds, p = 0.001). In addition, the catheter malposition rate in group A was significantly lower than that in group B (0% v 11.4%, p = 0.049). Conversely, there were no significant differences in the total access time, overall success rate, and complications (eg, pneumothorax, hemorrhage, puncture artery, and nerve injury) between the 2 groups.
For children with congenital heart disease requiring central venous catheterization during the perioperative period, the subclavian vein is a feasible site for catheterization. The supraclavicular approach, especially the left side, has a higher first-puncture success rate, shorter access time, lower complications, and a trend of lower incidence of catheter malposition. However, a larger sample size of a randomized controlled study is expected to verify the advantages of ultrasound-guided subclavian catheterization in children.
中心静脉置管在危重症儿科患者中广泛应用。本研究旨在比较经锁骨下和锁骨上两种途径行超声引导下锁骨下静脉穿刺置管的成功率和安全性。
将需要中心静脉置管的先天性心脏病患儿随机分为锁骨上途径组（A 组）和锁骨下途径组（B 组），比较两组患儿首次穿刺成功率及置管相关信息。
医科大学附属医院儿科心脏重症监护病房。
术前诊断为先天性心脏病、入住心脏重症监护病房且需要锁骨下静脉置管的患儿。
超声引导下锁骨下静脉穿刺置管。
本研究共纳入 67 例患儿，其中 A 组 32 例，B 组 35 例。结果显示，两组患儿首次穿刺成功率差异有统计学意义（90.6%比 71.4%，%，p = 0.047）。此外，A 组的置管用时为 11.8 秒（3.295），明显短于 B 组的 16.0 秒（6.5227），p = 0.001。A 组导管异位率明显低于 B 组（0%比 11.4%，p = 0.049）。两组患儿的总置管用时、总体成功率及并发症（气胸、出血、误穿动脉、神经损伤等）差异均无统计学意义。
对于围术期需要中心静脉置管的先天性心脏病患儿，锁骨下静脉是可行的置管部位。锁骨上途径，尤其是左侧，首次穿刺成功率更高，置管用时更短，并发症更少，且导管异位发生率更低。但仍需要更大样本量的随机对照研究来验证超声引导下锁骨下置管在儿童中的优势。
