Brachiocephalic vein for percutaneous ultrasound-guided central line positioning in children: A 20-month preliminary experience with 109 procedures

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Abstract

BACKGROUND: Ultrasound-guided (USG) cannulation of the brachiocephalic vein (BCV) is gaining worldwide consensus for central venous access in children. This study reports a 20-month experience with this approach in children.

METHODS: All patients who underwent percutaneous USG central venous catheter (CVC) positioning in the BCV between August 2013 and March 2015 have been included. Devices inserted during this period were open-ended, either single or double-lumen tunneled CVC. Our series was divided into three consecutive study periods in order to determine the relative incidence of repositioning and complications.

RESULTS: During the study period, a total of 95 patients underwent 109 CVC insertions in the BCV. The median length of CVC duration was 230 days for a total of 23,212 catheter days. No major intraoperative complications occurred. Overall rate of CVC-related postoperative complications requiring repositioning or precocious removal was 0.90 per 1,000 catheter days and involved 21 CVC (19%, 95% confidence interval 13-28). These included 18 dislodgments, two infections, and one malfunction. Double-lumen CVCs represented the only significant risk factor for complications (52% complications-three per 1,000 catheter days).

CONCLUSION: USG supraclavicular cannulation of the BCV represents a safe approach for central line placement in children. It proved to be versatile, as it can be used in premature infants as well as in adolescents. Provided it is adopted by operators experienced in USG cannulation, we strongly suggest to resort to this approach as a first-line choice in children undergoing tunnelled central line placement for long-lasting therapy.

Original languageEnglish
Pages (from-to)330-335
Number of pages6
JournalPediatric Blood and Cancer
Volume64
Issue number2
DOIs
Publication statusPublished - Feb 2017

Fingerprint

Brachiocephalic Veins
Central Venous Catheters
Catheterization
Catheters
Intraoperative Complications
Premature Infants
Confidence Intervals
Equipment and Supplies
Incidence
Infection

Keywords

  • Adolescent
  • Adult
  • Brachiocephalic Veins
  • Catheterization, Central Venous
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Neoplasms
  • Postoperative Complications
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Time Factors
  • Ultrasonography, Interventional
  • Young Adult
  • Journal Article

Cite this

@article{1529307e1e744b82abdc86405926b97d,
title = "Brachiocephalic vein for percutaneous ultrasound-guided central line positioning in children: A 20-month preliminary experience with 109 procedures",
abstract = "BACKGROUND: Ultrasound-guided (USG) cannulation of the brachiocephalic vein (BCV) is gaining worldwide consensus for central venous access in children. This study reports a 20-month experience with this approach in children.METHODS: All patients who underwent percutaneous USG central venous catheter (CVC) positioning in the BCV between August 2013 and March 2015 have been included. Devices inserted during this period were open-ended, either single or double-lumen tunneled CVC. Our series was divided into three consecutive study periods in order to determine the relative incidence of repositioning and complications.RESULTS: During the study period, a total of 95 patients underwent 109 CVC insertions in the BCV. The median length of CVC duration was 230 days for a total of 23,212 catheter days. No major intraoperative complications occurred. Overall rate of CVC-related postoperative complications requiring repositioning or precocious removal was 0.90 per 1,000 catheter days and involved 21 CVC (19{\%}, 95{\%} confidence interval 13-28). These included 18 dislodgments, two infections, and one malfunction. Double-lumen CVCs represented the only significant risk factor for complications (52{\%} complications-three per 1,000 catheter days).CONCLUSION: USG supraclavicular cannulation of the BCV represents a safe approach for central line placement in children. It proved to be versatile, as it can be used in premature infants as well as in adolescents. Provided it is adopted by operators experienced in USG cannulation, we strongly suggest to resort to this approach as a first-line choice in children undergoing tunnelled central line placement for long-lasting therapy.",
keywords = "Adolescent, Adult, Brachiocephalic Veins, Catheterization, Central Venous, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Infant, Infant, Newborn, Male, Neoplasms, Postoperative Complications, Prognosis, Prospective Studies, Risk Factors, Time Factors, Ultrasonography, Interventional, Young Adult, Journal Article",
author = "Stefano Avanzini and Leila Mameli and Nicola Disma and Clelia Zanaboni and Andrea Dato and Giovanni Montobbio and Luigi Montagnini and Michela Bevilacqua and Filomena Pierri and Massimo Conte and Loredana Amoroso and Giovanna Pala and Sara Pestarino and Elio Castagnola and Molinari, {Angelo Claudio} and Concetta Micalizzi and Giuseppe Morreale and Girolamo Mattioli and {Pini Prato}, A",
note = "{\circledC} 2016 Wiley Periodicals, Inc.",
year = "2017",
month = "2",
doi = "10.1002/pbc.26202",
language = "English",
volume = "64",
pages = "330--335",
journal = "Pediatric Blood and Cancer",
issn = "1545-5009",
publisher = "John Wiley and Sons Inc.",
number = "2",

}

TY - JOUR

T1 - Brachiocephalic vein for percutaneous ultrasound-guided central line positioning in children

T2 - A 20-month preliminary experience with 109 procedures

AU - Avanzini, Stefano

AU - Mameli, Leila

AU - Disma, Nicola

AU - Zanaboni, Clelia

AU - Dato, Andrea

AU - Montobbio, Giovanni

AU - Montagnini, Luigi

AU - Bevilacqua, Michela

AU - Pierri, Filomena

AU - Conte, Massimo

AU - Amoroso, Loredana

AU - Pala, Giovanna

AU - Pestarino, Sara

AU - Castagnola, Elio

AU - Molinari, Angelo Claudio

AU - Micalizzi, Concetta

AU - Morreale, Giuseppe

AU - Mattioli, Girolamo

AU - Pini Prato, A

N1 - © 2016 Wiley Periodicals, Inc.

PY - 2017/2

Y1 - 2017/2

N2 - BACKGROUND: Ultrasound-guided (USG) cannulation of the brachiocephalic vein (BCV) is gaining worldwide consensus for central venous access in children. This study reports a 20-month experience with this approach in children.METHODS: All patients who underwent percutaneous USG central venous catheter (CVC) positioning in the BCV between August 2013 and March 2015 have been included. Devices inserted during this period were open-ended, either single or double-lumen tunneled CVC. Our series was divided into three consecutive study periods in order to determine the relative incidence of repositioning and complications.RESULTS: During the study period, a total of 95 patients underwent 109 CVC insertions in the BCV. The median length of CVC duration was 230 days for a total of 23,212 catheter days. No major intraoperative complications occurred. Overall rate of CVC-related postoperative complications requiring repositioning or precocious removal was 0.90 per 1,000 catheter days and involved 21 CVC (19%, 95% confidence interval 13-28). These included 18 dislodgments, two infections, and one malfunction. Double-lumen CVCs represented the only significant risk factor for complications (52% complications-three per 1,000 catheter days).CONCLUSION: USG supraclavicular cannulation of the BCV represents a safe approach for central line placement in children. It proved to be versatile, as it can be used in premature infants as well as in adolescents. Provided it is adopted by operators experienced in USG cannulation, we strongly suggest to resort to this approach as a first-line choice in children undergoing tunnelled central line placement for long-lasting therapy.

AB - BACKGROUND: Ultrasound-guided (USG) cannulation of the brachiocephalic vein (BCV) is gaining worldwide consensus for central venous access in children. This study reports a 20-month experience with this approach in children.METHODS: All patients who underwent percutaneous USG central venous catheter (CVC) positioning in the BCV between August 2013 and March 2015 have been included. Devices inserted during this period were open-ended, either single or double-lumen tunneled CVC. Our series was divided into three consecutive study periods in order to determine the relative incidence of repositioning and complications.RESULTS: During the study period, a total of 95 patients underwent 109 CVC insertions in the BCV. The median length of CVC duration was 230 days for a total of 23,212 catheter days. No major intraoperative complications occurred. Overall rate of CVC-related postoperative complications requiring repositioning or precocious removal was 0.90 per 1,000 catheter days and involved 21 CVC (19%, 95% confidence interval 13-28). These included 18 dislodgments, two infections, and one malfunction. Double-lumen CVCs represented the only significant risk factor for complications (52% complications-three per 1,000 catheter days).CONCLUSION: USG supraclavicular cannulation of the BCV represents a safe approach for central line placement in children. It proved to be versatile, as it can be used in premature infants as well as in adolescents. Provided it is adopted by operators experienced in USG cannulation, we strongly suggest to resort to this approach as a first-line choice in children undergoing tunnelled central line placement for long-lasting therapy.

KW - Adolescent

KW - Adult

KW - Brachiocephalic Veins

KW - Catheterization, Central Venous

KW - Child

KW - Child, Preschool

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Infant

KW - Infant, Newborn

KW - Male

KW - Neoplasms

KW - Postoperative Complications

KW - Prognosis

KW - Prospective Studies

KW - Risk Factors

KW - Time Factors

KW - Ultrasonography, Interventional

KW - Young Adult

KW - Journal Article

U2 - 10.1002/pbc.26202

DO - 10.1002/pbc.26202

M3 - Article

C2 - 27578550

VL - 64

SP - 330

EP - 335

JO - Pediatric Blood and Cancer

JF - Pediatric Blood and Cancer

SN - 1545-5009

IS - 2

ER -