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Ultrasound-guided or landmark techniques for central venous catheter placement in critically ill children

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Abstract

Purpose

To assess whether ultrasound guidance improves central venous catheter placement outcomes compared to the landmark technique in critically ill children.

Methods

A prospective multicentre observational study was carried out in 26 paediatric intensive care units over 6 months. Children 0–18 years old who received a temporary central venous catheter, inserted using either ultrasound or landmark techniques, were eligible. The primary outcome was the first-attempt success rate. Secondary outcomes included overall placement success, number of puncture attempts, number of procedures requiring multiple punctures (> 3 punctures), number of procedures requiring punctures at more than one vein site and immediate mechanical complications. To account for potential confounding factors, we used propensity scores. Our primary analysis was based on 1:1 propensity score matching. The association between cannulation technique and outcomes in the matched cohort was estimated using generalized estimating equations and mixed-effects models to account for patient-level and hospital-level confounders.

Results

Five hundred central venous catheter-placement procedures involving 354 patients were included. Ultrasound was used for 323 procedures, and the landmark technique was used for 177. Two hundred and sixty-six procedures were matched (133 in the ultrasound group and 133 in the landmark group). Ultrasound was associated with an increase in the first-attempt success rate [46.6 vs. 30%, odds ratio 2.09 (1.26–3.46); p < 0.001], a reduced number of puncture attempts [2 (1–3) vs. 2 (1–4), B coefficient − 0.51 (95% confidence interval − 1.01 to − 0.03), p = 0.035], and fewer overall mechanical complications [12 vs. 22.5%, odds ratio 0.47 (95% confidence interval 0.24–0.91), p = 0.025] in the matched cohort. The number of puncture attempts was the main factor associated with overall complications.

Conclusions

Compared with the landmark technique, ultrasound guidance was associated with an increased first-attempt success rate, a reduced number of puncture attempts, and fewer complications during central venous catheter placement in critically ill children.

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Acknowledgements

The authors wish to thank all the collaborators for their participation in the RECANVA study.

RECANVA collaborative study. Other members of the RECANVA collaborative study are: Manuel Ortiz-Pallares. Paediatric Intensive Care Unit. Hospital Universitario Alvaro Cunqueiro. Estrada Clara Campoamor, 341, 36212 Vigo. (Spain)a, Emilia Fernández-Romero. Paediatric Intensive Care Unit. Hospital Universitario Virgen de la Macarena. Avenida Doctor Fedriani, 3, 41009 Sevilla (Spain)a, Soledad Torrús-Carmona. Paediatric and Neonatal Intensive Care Unit. Complejo Hospitalario de Navarra. Calle de Irunlarrea, 3, 31008 Pamplona (Spain)a, Alicia Mirás-Veiga. Paediatric Intensive Care Unit. Hospital Universitario de Burgos. Avda. Islas Baleares, 3, 09006 Burgos (Spain)a,b, María García-Barba. Paediatric Intensive Care Unit. Hospital Universitario Monte Príncipe. Av. de Montepríncipe, 25, 28660 Boadilla del Monte. (Spain)a, Esther Jimenez. Paediatric Intensive Care Unit. Hospital Universitari de Girona Doctor Josep Trueta. Avinguda de França, S/N, 17007 Girona. (Spain)a, María Pino-Velázquez. Paediatric Intensive Care Unit. Hospital Clínico Universitario de Valladolid. Av. Ramón y Cajal, 3, 47003 Valladolid (Spain)a, Virginia González-Ojeda. Paediatric Intensive Care Unit. Hospital Universitario Quirón-Salud. Calle Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, (Spain)a, Amalia Martínez-Antón. Paediatric Intensive Care Unit. Hospital Universitario Fundación Jiménez Díaz. Av. Reyes Católicos, 2, 28040 Madrid (Spain)a, Carolina González-Miño. Paediatric Intensive Care Unit. Hospital General de Castellón. Avinguda de Benicàssim, s/n, 12004 Castelló de la Plana, (Spain)a.

aRECANVA collaborative study.

bWorking Group on Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care.

Author information

Authors and Affiliations

  1. Paediatric Intensive Care Unit, Complejo Asistencial Universitario de León, Altos de Nava s/n, 24008, León, Spain

    Ignacio Oulego-Erroz

  2. Paediatric Intensive Care Unit, Hospital Materno-Infantil Universitario Gregorio Marañón, Calle de O’Donnell, 48, 28009, Madrid, Spain

    Rafael González-Cortes

  3. Paediatric Intensive Care Unit, Hospital Universitario Carlos Haya de Málaga, Av. de Carlos Haya, s/n, 29011, Málaga, Spain

    Patricia García-Soler

  4. Paediatric Intensive Care Unit, Hospital Sant Joan de Dèu, Passeig Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Spain

    Mónica Balaguer-Gargallo

  5. Paediatric Intensive Care Unit, Hospital Reina Sofía de Córdoba, Av. Menéndez Pidal, s/n, 14004, Córdoba, Spain

    Manuel Frías-Pérez

  6. Paediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Av. De Roma, s/n, 33011, Oviedo, Asturias, Spain

    Juan Mayordomo-Colunga

  7. Paediatric Intensive Care Unit, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain

    Ana Llorente-de-la-Fuente

  8. Paediatric Intensive Care Unit, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Av. de Barber, 30, 45004, Toledo, Spain

    Paula Santos-Herraiz

  9. Paediatric Intensive Care Unit, Hospital de La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain

    Juan José Menéndez-Suso

  10. Paediatric Intensive Care Unit, Hospital Universitario Ramón y Cajal. Ctra, Colmenar Viejo, km. 9,100, 28034, Madrid, Spain

    María Sánchez-Porras

  11. Paediatric Intensive Care Unit, Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009, Saragossa, Spain

    Daniel Palanca-Arias

  12. Paediatric Intensive Care Unit, Hospital Universitario Son Espases, Carr. de Valldemossa, 79, 07120, Palma, Islas Baleares, Spain

    Carmen Clavero-Rubio

  13. Paediatric Intensive Care Unit, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain

    Mª Soledad Holanda-Peña

  14. Paediatric Intensive Care Unit, Parc Taulí Hospital Universitari, Parc Taulí, 1, 08208, Sabadell, Barcelona, Spain

    Luis Renter-Valdovinos

  15. Paediatric Intensive Care Unit, Hospital Universitario de Salamanca, Paseo de San Vicente, 88-182, 37007, Salamanca, Spain

    Sira Fernández-De-Miguel

  16. Paediatric and Emergency Care Department, Complejo Hospitalario Universitario de Santiago de Compostela, Travesía de Choupana, s/n, 15706, Santiago de Compostela, Spain

    Antonio Rodríguez-Núñez

Authors
  1. Ignacio Oulego-Erroz
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  2. Rafael González-Cortes
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  3. Patricia García-Soler
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  4. Mónica Balaguer-Gargallo
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  5. Manuel Frías-Pérez
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  6. Juan Mayordomo-Colunga
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  7. Ana Llorente-de-la-Fuente
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  8. Paula Santos-Herraiz
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  9. Juan José Menéndez-Suso
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  10. María Sánchez-Porras
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  11. Daniel Palanca-Arias
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  12. Carmen Clavero-Rubio
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  13. Mª Soledad Holanda-Peña
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  14. Luis Renter-Valdovinos
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  15. Sira Fernández-De-Miguel
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  16. Antonio Rodríguez-Núñez
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Consortia

RECANVA collaborative study

  • Manuel Ortiz-Pallares
  • , Emilia Fernández-Romero
  • , Soledad Torrús-Carmona
  • , Alicia Mirás-Veiga
  • , María García-Barba
  • , Esther Jimenez
  • , María Pino-Velázquez
  • , Virginia González-Ojeda
  • , Amalia Martínez-Antón
  •  & Carolina González-Miño

Corresponding author

Correspondence to Ignacio Oulego-Erroz.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Additional information

Ignacio Oulego-Erroz: RECANVA collaborative study; Working Group on Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care; IBIOMED: Institute of Biomedicine, University of León (Spain).

Rafael González-Cortes: RECANVA collaborative study; Working Group on Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care; Gregorio Marañon Heath Research Institute, Madrid, Spain; Mother–Child Health and Development Network (SAMID Network) of Carlos III Health Institute, Spain. SAMID Network: ref RD12/0026/0001.

Patricia García-Soler: RECANVA collaborative study; Working Group on Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care.

Mónica Balaguer-Gargallo: RECANVA collaborative study; Working Group on Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care.

Manuel Frías-Pérez: RECANVA collaborative study; Working Group on Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care.

Juan Mayordomo-Colunga: RECANVA collaborative study; Working Group on Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care; CIBER-Enfermedades Respiratorias, Instituto Carlos III (Spain).

Ana Llorente-de-la-Fuente: RECANVA collaborative study; Working Group on Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care.

Paula Santos-Herraiz: RECANVA collaborative study.

Juan José Menéndez-Suso: RECANVA collaborative study; Working Group on Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care.

María Sánchez-Porras: RECANVA collaborative study; Working Group on Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care.

Daniel Palanca-Arias: RECANVA collaborative study; Working Group on Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care.

Carmen Clavero-Rubio: RECANVA collaborative study; Working Group on Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care.

Mª Soledad Holanda-Peña: RECANVA collaborative study. Luis Renter-Valdovinos: RECANVA collaborative study; Working Group on Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care.

Sira Fernández-De-Miguel: RECANVA collaborative study.

Antonio Rodríguez-Núñez: RECANVA collaborative study; Working Group on Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care; Mother–Child Health and Development Network (SAMID Network) of Carlos III Health Institute, Spain. SAMID Network: ref RD12/0026/0001.

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Oulego-Erroz, I., González-Cortes, R., García-Soler, P. et al. Ultrasound-guided or landmark techniques for central venous catheter placement in critically ill children. Intensive Care Med 44, 61–72 (2018). https://doi.org/10.1007/s00134-017-4985-8

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