Tag Archives: Central Venous Catheterization

The microbiological and clinical outcome of guide wire exchanged versus newly inserted antimicrobial surface treated central venous catheters. (Kamat)

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Parbat N, Sherry N, Bellomo R, Schneider AG, Glassford NJ, Johnson PD, Bailey M. The microbiological and clinical outcome of guide wire exchanged versus newly inserted antimicrobial surface treated central venous catheters. Crit Care. 2013 Sep 3;17(5):R184.

INTRODUCTION: The management of suspected central venous catheter (CVC)-related sepsis by guide wire exchange (GWX) is not recommended. However, GWX for new antimicrobial surface treated (AST) triple lumen CVC’s has never been studied. We aimed to compare the microbiological outcome of triple lumen AST CVC’s inserted by GWX (GWX-CVC’s) with newly inserted triple lumen AST CVC’s (NI-CVC’s).

METHODS: We studied a cohort of 145 consecutive patients with GWX-CVC’s and contemporaneous site-matched control cohort of 163 patients with a NI-CVC’s in a tertiary intensive care unit (ICU).

RESULTS: GWX-CVC and NI-CVC patients were similar for mean age (58.7 vs. 62.2 years), gender (88 (60.7%) vs. 98 (60.5%) male) and illness severity on admission (mean APACHE III: 71.3 vs. 72.2). However, GWX patients had longer median ICU length of stay (12.2 vs. 4.4 days; P<0.001) and median hospital length of stay (30.7 vs. 18.0 days; P <0.001). There was no significant difference with regard to the number of CVC tips with bacterial or fungal pathogen colonization among GWX-CVC’s vs. NI-CVC’s [5 (2.5%) vs. 6 (7.4%); P = 0.90]. Catheter-associated blood stream infection (CA-BSI) occurred in 2 (1.4%) GWX patients compared with 3 (1.8%) NI-CVC patients (p=0.75). There was no significant difference in hospital mortality [35 (24.1%) vs. 48 (29.4%); P= 0.29].

CONCLUSIONS: GWX-CVC’s and NI-CVC’s had similar rates of tip colonization at removal, CA-BSI and mortality. If the CVC removed by GWX is colonized, a new CVC must then be inserted at another site. In selected ICU patients at higher central vein puncture risk receiving AST CVC’s GWX may be an acceptable initial approach to line insertion.

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A review of 5434 percutaneous pediatric central venous catheters inserted by anesthesiologists. (Kamat)

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Malbezin S, Gauss T, Smith I, Bruneau B, Mangalsuren N, Diallo T, Skhiri A, Nivoche Y, Dahmani S, Brasher C. A review of 5434 percutaneous pediatric central venous catheters inserted by anesthesiologists. Paediatr Anaesth. 2013 Nov;23(11):974-979.

OBJECTIVE: To review the results of an anesthesiologist led pediatric percutaneous central venous access service.

METHODS: Prospective data on percutaneous pediatric central venous catheter (CVC) insertions were collected over 22 years. Data included age, gender, weight, previous central CVCs, venous thromboses, investigations for great vein patency, type of CVC, external diameter, previous CVC insertions, intended use, operator identity, and the vein into which the CVC was inserted. The default technique was internal jugular vein cannulation using landmark technique (LT). Complication was defined as the following: failure to cannulate any vein, hemothorax, pneumothorax, right atrial perforation, extravenous wire positioning or CVC position and whether the patient was taken back to theater for CVC repositioning.

RESULTS: Five thousand four hundred and thirty-four percutaneous CVC insertion procedures were performed on 3954 patients. One-third involved children <1 year of age (n = 1823: 34%). Five thousand one hundred and twenty-five CVCs (95.3%) were inserted into internal jugular veins. The majority were tunneled CVCs (n = 5190: 96.2%). The perioperative complication rate was 1.3%. Successful cannulation occurred in 99.5% of patients. Failure was more likely in children ❤ kg, during large bore hemodialysis CVC insertions and during the first 4 years of the service – the latter suggesting a learning curve. Ninety-nine percent of CVCs were inserted using LTs.

CONCLUSION: This study demonstrates a high success rate and low complication rate during pediatric percutaneous internal jugular vein CVC insertions by trained anesthesiologists using LTs. Smaller children, hemodialysis CVCs, and the team’s learning curve were identified as risk factors for insertion failure.

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Supraclavicular ultrasound-guided catheterization of the subclavian vein in pediatric and neonatal ICUs: a feasibility study. (Ruth)

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Pediatr Crit Care Med. 2013 May;14(4):351-5. PMID: 23392376

OBJECTIVES: To assess the feasibility of ultrasound-guided supraclavicular catheterization of the subclavian vein in pediatric and neonatal ICU.

DESIGN: Retrospective cohort.

SETTING: Ten-bed pediatric medicosurgical ICU and 15-bed neonatal ICU.

PATIENTS: Children and newborns undergoing supraclavicular ultrasound-guided subclavian vein catheterization from March 2010 to September 2010.

MEASUREMENTS: The placement of central venous catheter in ICU was carried out either by one of the experts in ultrasound-guided puncture of the unit or by a novice completely supervised by the expert. The success and the early complications were recorded. A comparison between novice and expert operators was also made.

RESULTS: Forty-two catheters were placed in 40 children. The median age and median weight were, respectively, 6.5 months and 6.5 kg. The success rate was 97.6% (one failure) and the early complication rate was 4.7% (one pneumothorax and one arterial puncture); 61% of children breathed spontaneously during the catheter placement. No significant difference was found between expert and novice operators.

CONCLUSIONS: Supraclavicular ultrasound-guided catheterization of the subclavian vein in pediatric and neonatal ICU seems to be a promising technique in the context of emergency. It is safe, reliable, with few early complications. Furthermore, it does not compromise the airways of the patient owing to the low level of sedation needed for its placement.

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