Have an account? Please log in.
Text size: Small font Default font Larger font
.
Radiology Daily
Radiology Daily PracticalReviews.com Radiology Daily

Using Ultrasound to Guide the Placement of Central Lines: Children versus Adults

November 20, 2009
Written by: , Filed in: Pediatric Radiology
  • Comments
.

Using ultrasound to guide the needle in central venous catheterization (CVC) has improved success rates and decreased complication rates in the adult and pediatric patient alike.

A recent study was conducted to compare the complication rates, technical details, and success rates of CVC between adult and pediatric populations.

The study has concluded that ultrasound-guided CVC is a safe procedure in both adults and children, but that a complication rate of about 2.4%. CVC under ultrasound guidance in infants <1 year old is technically challenging.

Design and Methods

This is a retrospective chart review of all CVCs performed between 2002 and 2006. Demographics of the patient, indication, type of anesthesia, type of puncture (single or double wall), site of catheterization, number of attempts, and technical success of placing a line in the intended vein were recorded.

The preferred site of access was the internal jugular vein, with a 21-G needle used for children and an 18-G needle used for adults.

The pediatric patients were further subdivided into 3 groups based on age:

  • <1 year
  • 1 to 5 years
  • >5 years.

Comparisons were made between pediatric and adult patients and among pediatric subgroups.

Results of the Study
859 central venous lines were inserted in 688 adults, whereas 247 catheters were inserted in 156 children during the study period.

The technical success rate (99% vs 90%), the rate of first attempt success, and the rate of single wall puncture were significantly higher in adults than in pediatric patients.

The mean number of punctures was significantly lower in adults than in children.

Pediatric Diagnostic Imaging

The Society for Pediatric Radiology
Pediatric Diagnostic Imaging program features the advances and diversity of pediatric imaging by reviewing state-of-the-art clinical material and advanced cutting-edge research presentations. This program presents a group of international experts who discuss state-of-the art diagnostic imaging and the outlook for the future direction of the specialty.
Read more or order:  Pediatric Diagnostic Imaging

Within the pediatric subgroups, the rates of technical success (77% vs 97% to 100%), successful first attempt, and single-wall puncture were significantly lower in patients aged <1 year. The mean number of attempts was also significantly higher in patients aged <1 year.

As for the site of puncture, the technical success rate was higher for the internal jugular vein than for other sites in pediatric patients (92.3% vs 78.9%). In adults, any failure to cannulate the central veins were due to central vein occlusion.

In the pediatric population, failure to pass the wire was the reason of failure, regardless of whether the veins were open. The failure rate for placing a central line in a given vein was 0.58% in adults and 9.7% in children. The complication rates were the same for both groups, 2.3% in adults and 2.4% in children. All complications were minor.

Reviewer’s Comments
This retrospective study proves what was already known clinically
in general.

Ultrasound-guided CVC is a safe procedure in both adults and children with a complication rate of about 2.4%.

CVC in children aged <1 year is technically difficult, despite good operator experience.

Regardless, the complication rates were the same in children and adults and did not include pneumothorax or hemothorax, as is seen when CVC is attempted using landmarks.

The use of ultrasound guidance increases the success rate, and decreases the complication rate in all ages, and this study verifies that finding.

Author: Sharon Gonzales, MD

Reference:
Tercan F, Oguzkurt L, et al. Comparison of Ultrasonography-Guided Central Venous Catheterization Between Adult and Pediatric Populations. Cardiovasc Intervent Radiol; 2008; 31 (May): 575-580

Pediatric Diagnostic Imaging

The Society for Pediatric Radiology
Pediatric Diagnostic Imaging program features the advances and diversity of pediatric imaging by reviewing state-of-the-art clinical material and advanced cutting-edge research presentations. This program presents a group of international experts who discuss state-of-the art diagnostic imaging and the outlook for the future direction of the specialty.
Read more or order:  Pediatric Diagnostic Imaging
.

Permalink: http://www.radiologydaily.com/?p=1305

Tags: , , , , , , , , , , , , , ,

  • Comments
.

Would you like to keep current with radiological news and information?

Post Your Comments and Responses

Comments are closed.