J Korean Assoc Pediatr Surg.  1998 Jun;4(1):1-15. 10.13029/jkaps.1998.4.1.1.

Central Venous Access in Children

• Lee MD

• KMID: 2422222
• DOI: http://doi.org/10.13029/jkaps.1998.4.1.1

Abstract

To evaluate the profitable central venous catheters (CVCs) in children, 320 CVCs placed in 255 neonate and children over a 10-year period were analyzed retrospectively. CVC was provided by one pediatric surgeon for a total of 6,116 patients days. The number of perioperative group including immediate TPN or chemo was 223, CVC just for TPN was 57 and chemotherapy 40. Local anesthesia was applied in 71 cases, and the others were under the general anesthesia. Subclavian vein catheterizations (SCVs) were 202 cases (82 infants and neonates), tunneled external jugular venotomy(EJV) 38, tunneled internal jugular venotomy(IJV) 2, facial venotomy (FV) 3, and umbilical venous catheterization (UVC) with vein transposition 74. In neonates, 72 UVCs were applied during laparotomy. SCV was increased with ages, 3 kg of minimal body weight. The average catheter-periods over-all were 19.1 days, of SCV 17 days, EJV 40, IJV 60 and UVC 14. Technical complications were; arterial puncture (6), puncture failure (5) and abnormal location(12) in SCV; insertion failure (3) in EJV; abnormal location in the portal vein (4) and the liver parenchyma (2) making cystic fluid accumulations in UVC. Twelve migrations (3.8%) out of position occurred; SCV(2), EJV (1) and UVC (9). For 4 cases (1.2 %) of catheter obstruction and 11 (3.4 %) of catheter infection (3 SCV, 2 EJV and 6 UVC), rescue procedures were applied with some achievements. There was one mortality (0.3 %) due to deep sedation in 1.06 kg baby for EJV. Cumulated surgeon's experience of the crafts, proper catheter selection and keeping the safety rouls would be the important factors for successful CVCs.

Keyword

Central venous access; Catheter; Pediatric; External jugular vein; subclavian vein; umbilical vein

MeSH Terms

Anesthesia, General
Anesthesia, Local
Body Weight
Catheter Obstruction
Catheterization
Catheters
Central Venous Catheters
Child*
Deep Sedation
Drug Therapy
Humans
Infant
Infant, Newborn
Laparotomy
Liver
Mortality
Portal Vein
Punctures
Retrospective Studies
Subclavian Vein
Umbilical Veins
Veins