Comparison of ultrasound-guided central venous catheterization versus anatomical landmarks in pediatric critically ill patients: a prospective study
DOI:
https://doi.org/10.56294/saludcyt2023522Keywords:
Central Venous Catheterization, Interventional Ultrasonography, Pediatrics Critical IllnessAbstract
Introduction: central venous catheterization is a common procedure in critically ill pediatric patients, but its accurate and safe performance remains a challenge.
Objective: to determine if ultrasound-guided central venous catheterization improves the first-attempt success rate and reduces the risk of complications compared with the landmark-based approach in pediatric critically ill patients.
Methods: a prospective study was carried out that included 100 critical pediatric patients, divided into two groups: ultrasound-guided catheterization (n=43) and anatomical references (n=47). Demographic and clinical data were collected, variables of interest were recorded, and logistic regression analysis adjusted for patient age, access site, and operator was performed.
Results: ultrasound-guided central venous catheterization showed a significantly higher first-attempt success rate compared with anatomic references (81,4 % vs. 57,4 %, p<0,05). In addition, a significant reduction in procedural complications was observed in the ultrasound-guided group compared to the anatomical reference group (4,7 % vs. 12,8 %, p<0.05).
Conclusions: the use of ultrasound as a guide improves the success rate in the first attempt and reduces the risk of complications during the procedure. These findings highlight the importance of considering ultrasound-guided catheterization as a preferred strategy in the management of critically ill pediatric patients requiring central venous access
References
1. Kolikof J, Peterson K, Baker AM. Central Venous Catheter. En: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. http://www.ncbi.nlm.nih.gov/books/NBK557798/
2. Ares G, Hunter CJ. Central venous access in children: indications, devices, and risks. Curr Opin Pediatr. 2017;29(3):340–6. https://doi.org/10.1097/mop.0000000000000485
3. Duesing LA, Fawley JA, Wagner AJ. Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies. Nutr Clin Pract. 2016;31(4):490–501. https://doi.org/10.1177/0884533616640454
4. Kamra K, Hammer GB. Central venous catheter placement in children: ‘How good is good enough?’ Pediatric Anesthesia. 2013;23(11):971–3. https://doi.org/10.1111/pan.12228
5. Lamperti M, Biasucci DG, Disma N, Pittiruti M, Breschan C, Vailati D, et al. European Society of Anaesthesiology guidelines on peri-operative use of ultrasound-guided for vascular access (PERSEUS vascular access). Eur J Anaesthesiol. 2020;37(5):344–76. https://doi.org/10.1097/eja.0000000000001180
6. Azizov S, Sahutoglu C, Bor C, Balcioglu T. Do not trust landmarks and your feelings while inserting pediatric central venous catheters. Ain-Shams Journal of Anesthesiology. 2022;14(1):95. https://doi.org/10.1186/s42077-022-00293-4
7. Kozyak BW, Yuerek M, Conlon TW. Contemporary Use of Ultrasonography in Acute Care Pediatrics. Indian J Pediatr. 2023;90(5):459–69. https://doi.org/10.1007/s12098-023-04475-2
8. Oulego-Erroz I, González-Cortes R, García-Soler P, Balaguer-Gargallo M, Frías-Pérez M, Mayordomo-Colunga J, et al. Ultrasound-guided or landmark techniques for central venous catheter placement in critically ill children. Intensive Care Med. 2018;44(1):61–72. https://doi.org/10.1007/s00134-017-4985-8
9. He C, Vieira R, Marin JR. Utility of Ultrasound Guidance for Central Venous Access in Children. Pediatr Emerg Care. 2017;33(5):359–62. https://doi.org/10.1097/pec.0000000000001124
10. de Souza TH, Brandão MB, Nadal JAH, Nogueira RJN. Ultrasound Guidance for Pediatric Central Venous Catheterization: A Meta-analysis. Pediatrics. 2018;142(5):e20181719. https://doi.org/10.1542/peds.2018-1719
11. Vafek V, Skříšovská T, Kosinová M, Klabusayová E, Musilová T, Kramplová T, et al. Central Venous Catheter Cannulation in Pediatric Anesthesia and Intensive Care: A Prospective Observational Trial. Children (Basel). 2022;9(11):1611. https://doi.org/10.3390%2Fchildren9111611
12. Eldabaa A, Elgebaly A, Elhafz A, Bassuni A. Comparison of ultrasound-guided vs. anatomical landmark-guided cannulation of the femoral vein at the optimum position in infant. Southern African Journal of Anaesthesia and Analgesia. 2012;18(3):162–6. https://doi.org/10.1080/22201173.2012.10872846
13. Bruzoni M, Slater BJ, Wall J, St Peter SD, Dutta S. A Prospective Randomized Trial of Ultrasound- vs Landmark-Guided Central Venous Access in the Pediatric Population. Journal of the American College of Surgeons. 2013;216(5):939–43. https://doi.org/10.1016/j.jamcollsurg.2013.01.054
14. Gurien LA, Blakely ML, Russell RT, Streck CJ, Vogel AM, Renaud EJ, et al. Real-time ultrasonography for placement of central venous catheters in children: A multi-institutional study. Surgery. 2016;160(6):1605–11. https://doi.org/10.1016/j.surg.2016.05.019
15. Calvache JA, Rodríguez MV, Trochez A, Klimek M, Stolker RJ, Lesaffre E. Incidence of Mechanical Complications of Central Venous Catheterization Using Landmark Technique: Do Not Try More Than 3 Times. J Intensive Care Med. 2016;31(6):397–402. https://doi.org/10.1177/0885066614541407
16. Pietroboni PF, Carvajal CM, Zuleta YI, Ortiz PL, Lucero YC, Drago M, et al. Landmark versus ultrasound-guided insertion of femoral venous catheters in the pediatric intensive care unit: An efficacy and safety comparison study. Med Intensiva. 2020;44(2):96–100. https://doi.org/10.1016/j.medin.2019.07.014
17. Shime N, Hosokawa K, MacLaren G. Ultrasound Imaging Reduces Failure Rates of Percutaneous Central Venous Catheterization in Children. Pediatric Critical Care Medicine. 2015;16(8):718. https://doi.org/10.1097/PCC.0000000000000470
18. Lau CSM, Chamberlain RS. Ultrasound-guided central venous catheter placement increases success rates in pediatric patients: a meta-analysis. Pediatr Res. 2016;80(2):178–84. https://doi.org/10.1038/pr.2016.74
19. Froehlich CD, Rigby MR, Rosenberg ES, Li R, Roerig PLJ, Easley KA, et al. Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit. Crit Care Med. 2009;37(3):1090–6. https://doi.org/10.1097/ccm.0b013e31819b570e
20. Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database Syst Rev. 2015;1(1):CD011447. https://doi.org/10.1002/14651858.cd011447
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Copyright (c) 2023 Alfredo Carlos Rodríguez-Portelles , Arianna Maité Céspedes Rómulo, David Pascual Rojas Flores , Reynaldo Carvajal Choque , Francia Pérez Arellano , Evelin Resplandor Millan, Romer Guachichulca, Isaura Jaimes , Marielena Vivas Fernández (Author)
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