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Ultrasound-guided left brachiocephalic vein cannulation in children with underlying bleeding disorders: a retrospective analysis.

AbstractOBJECTIVES:
To evaluate the safety and effectiveness of ultrasound-guided left brachiocephalic vein cannulation in infants and children with underlying bleeding conditions.
DESIGN:
Retrospective cohort.
SETTING:
PICU of a tertiary pediatric hospital.
PATIENTS:
Thirty-four patients requiring central venous catheterization from January 2011 to January 2012.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
Two pediatric intensivists, experienced in ultrasound-guided vessel cannulation, performed the ultrasound catheterization of the left brachiocephalic vein. Ultrasound equipment consisted of a standard ultrasound monitor with a linear 6-13 MHz probe. The ultrasound monitor was set on a resolution with a depth of 1.8 cm for infants and 2.2 cm for children. The "in-plane" technique was used for all patients. Thirty-four catheterizations were performed. Patient median age was 12.5 months (5.75-63.5 mo) and median weight was 9.25 kg (7-16.25 kg). The population of infants and children analyzed was composed of 25 patients with hematologic disorder (73%) treated with hematopoietic stem cell transplantation, five patients (15%) supported with extracorporeal membrane oxygenation for viral pneumonias, and four patients (12%) with uremic hemolytic syndrome. A 4F catheter was used in 79% of cases. Left brachiocephalic vein cannulation was successful in all 34 patients. Median time needed for cannulation was 350 seconds (277.5-450 s). The overall complication rate was 9% (3 of 34) and consisted of difficulty in advancing the guidewire after having pierced the vein. The time required for catheter positioning and complications was not associated with both lower body weight and body surface area of the patients (p > 0.05). Mean central venous catheter duration was 32 ± 4 days.
CONCLUSIONS:
Data reported in this retrospective study confirm the safety and effectiveness of ultrasound-guided left brachiocephalic vein catheterization in infants and children with underlying bleeding disorders.
AuthorsMatteo Di Nardo, Francesca Stoppa, Marco Marano, Zaccaria Ricci, Maria Antonietta Barbieri, Corrado Cecchetti
JournalPediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (Pediatr Crit Care Med) Vol. 15 Issue 2 Pg. e44-8 (Feb 2014) ISSN: 1529-7535 [Print] United States
PMID24201856 (Publication Type: Journal Article)
Topics
  • Blood Coagulation Disorders (diagnostic imaging, surgery)
  • Brachiocephalic Veins (diagnostic imaging, surgery)
  • Catheterization, Central Venous (adverse effects, methods)
  • Child, Preschool
  • Cohort Studies
  • Female
  • Humans
  • Infant
  • Intensive Care Units, Pediatric
  • Male
  • Retrospective Studies
  • Ultrasonography, Interventional (adverse effects, methods)

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