Skip to main content
SpringerLink
Log in

Evaluation of a Novel Bony Landmark-Based Method for Teaching Percutaneous Insertion of Subclavian Venous Catheters in Pediatric Patients

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Surgical trainees performing subclavian vein (SCV) cannulation often incorrectly perceive needle trajectory and anatomical relations. As surface landmark-based methods derived from adult surgical practice may be less effective in younger patients, we developed and evaluated a novel bony landmark-based method for teaching SCV cannulation for central venous access device (CVAD) placement in children.

Methods

Over 2 sequential 3-year periods, pediatric surgical trainees were taught infraclavicular SCV cannulation via surface- and bony-landmark approaches, respectively. We prospectively recorded patient, surgeon and operative details on all Hickman line and port-a-cath insertions placed by trainees as the first surgeon via percutaneous infraclavicular SCV puncture and compared procedural outcomes and complications across both periods.

Results

Of 271 cases included in the study, trainees performed 52 (50.5%) and 92 (54.8%) procedures in the first and second periods, respectively. Patients in both periods did not differ by gender, disease, CVAD device, or prior CVAD, chemotherapy or infection status. In the second (bony landmark) period, although patients were younger (6.0 vs. 8.7 years, P = 0.003) mean procedural duration was shorter (42.5 vs. 58.3 min, P < 0.001). Also, cannulation attempts and complication rates did not differ significantly between study periods (P = 0.257 and 1.0, respectively).

Conclusions

With the bony landmark approach, trainees could perform the procedures faster despite operating on younger patients, without impacting complication rates and cannulation attempts. Bony landmarks may better approximate SCV position across a range of ages, thus improving the consistency of SCV cannulation in CVAD placements in children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bruzoni M, Slater BJ, Wall J, Peter SDS, Dutta S (2013) A prospective randomized trial of ultrasound- vs landmark-guided central venous access in the pediatric population. J Am Coll Surg 216(5):939

    Article  PubMed  Google Scholar 

  2. Byon HJ, Lee GW, Lee JH, Park YH, Kim HS, Kim CS et al (2013) Comparison between ultrasound-guided supraclavicular and infraclavicular approaches for subclavian venous catheterization in children—a randomized trial. Br J Anaesth 111(5):788–792

    Article  PubMed  Google Scholar 

  3. Tan B-K, Wong C-H, Ng R, Huang MHS, Lee S-T (2005) A modified technique of percutaneous subclavian venous catheterization in the oedematous burned patient. Burns 31(4):505–509

    Article  PubMed  Google Scholar 

  4. Parienti J-J, Mongardon N, Mégarbane B, Mira J-P, Kalfon P, Gros A et al (2015) Intravascular complications of central venous catheterization by insertion site. N Engl J Med 373(13):1220–1229

    Article  CAS  Google Scholar 

  5. Pirotte T, Veyckemans F (2007) Ultrasound-guided subclavian vein cannulation in infants and children: a novel approach. Br J Anaesth 98(4):509–514

    Article  CAS  PubMed  Google Scholar 

  6. Park SI, Kim YH, So SY, Kim MJ, Kim HJ, Kim JK (2013) Ultrasound-guided subclavian catheterization in pediatric patients with a linear probe: a case series. Korean J Anesthesiol 64(6):541–544

    Article  PubMed  PubMed Central  Google Scholar 

  7. Tan B-K, Hong S-W, Huang MHS, Lee S-T (2000) Anatomic basis of safe percutaneous subclavian venous catheterization. J Trauma Acute Care Surg 48(1):82

    Article  CAS  Google Scholar 

  8. Martynov I, Raedecke J, Klima-Frysch J, Kluwe W, Schoenberger J (2018) Outcome of landmark-guided percutaneously inserted tunneled central venous catheters in infants and children under 3 years with cancer. Pediatr Blood Cancer 65:e27295

    Article  PubMed  Google Scholar 

  9. Boon JM, Van Schoor AN, Abrahams PH, Meiring JH, Welch T, Shanahan D (2007) Central venous catheterization—an anatomical review of a clinical skill—part 1: subclavian vein via the infraclavicular approach. Clin Anat 20(6):602–611

    Article  CAS  PubMed  Google Scholar 

  10. Aminnejad R, Razavi SS, Mohajerani SA, Mahdavi SA (2015) Subclavian vein cannulation success rate in neonates and children. Anesthesiol Pain Med 5(3):e24156

    Article  Google Scholar 

  11. McGee DC, Gould MK (2003) Preventing complications of central venous catheterization. N Engl J Med 348(12):1123–1133

    Article  Google Scholar 

  12. Araujo CC, Lima MC, Falbo GH (2007) Punção percutênea da veia subclávia em crianças e adolescentes: sucesso, complicações e fatores associados. Jornal de Pediatria 83:64–70

    PubMed  Google Scholar 

  13. de Jonge RCJ, Polderman KH, Gemke RJBJ (2005) Central venous catheter use in the pediatric patient: mechanical and infectious complications. Pediatr Crit Care Med 6(3):329–339

    Article  PubMed  Google Scholar 

  14. Lefrant J-Y, Muller L, De La Coussaye J-E, Prudhomme M, Ripart J, Gouzes C et al (2002) Risk factors of failure and immediate complication of subclavian vein catheterization in critically ill patients. Intensive Care Med 28(8):1036–1041

    Article  PubMed  Google Scholar 

  15. Casado-Flores J, Valdivielso-Serna A, Pérez-Jurado L, Pozo-Román J, Monleón-Luque M, García-Pérez J et al (1991) Subclavian vein catheterization in critically ill children: analysis of 322 cannulations. Intensive Care Med 17(6):350–354

    Article  CAS  PubMed  Google Scholar 

  16. Kilbourne MJ, Bochicchio GV, Scalea T, Xiao Y (2009) Avoiding common technical errors in subclavian central venous catheter placement. J Am Coll Surg 208(1):104–109

    Article  PubMed  Google Scholar 

  17. Von Goedecke A, Keller C, Moriggl B, Wenzel V, Bale R, Deibl M et al (2005) An anatomic landmark to simplify subclavian vein cannulation: the “deltoid tuberosity”. Anesth Analg 100(3):623–628

    Article  Google Scholar 

  18. Thompson E, Calver L (2005) Safe subclavian vein cannulation. Am Surg 71(2):180–183

    PubMed  Google Scholar 

  19. Procter A, Lee L (2005) A radiological examination of the subclavian vein in vivo. Can J Anesth 52(1):A159

    Article  Google Scholar 

  20. Mitchell SE, Clark RA (1979) Complications of central venous catheterization. Am J Roentgenol 133(3):467

    Article  CAS  Google Scholar 

  21. Kang M, Ryu HG, Son IS, Bahk JH (2011) Influence of shoulder position on central venous catheter tip location during infraclavicular subclavian approach. Br J Anaesth 106(3):344–347

    Article  CAS  PubMed  Google Scholar 

  22. Kitagawa N, Oda M, Totoki T, Miyazaki N, Nagasawa I, Nakazono T et al (2004) Proper shoulder position for subclavian venipuncture: a prospective randomized clinical trial and anatomical perspectives using multislice computed tomography. Anesthesiology 101(6):1306–1312

    Article  PubMed  Google Scholar 

  23. Kim HJ, Jung SH, Min J, Hong DM, Jeon Y, Bahk JH (2013) Comparison of the neutral and retracted shoulder positions for infraclavicular subclavian venous catheterization: a randomized, non-inferiority trial. Br J Anaesth 111(2):191–196

    Article  CAS  PubMed  Google Scholar 

  24. Fukutome T, Shigematsu A (1986) Prediction of subclavian vein location using plain chest radiography. Resusc 14(4):237–243

    CAS  Google Scholar 

  25. Sandhu NS (2004) transpectoral ultrasound-guided catheterization of the axillary vein: an alternative to standard catheterization of the subclavian vein. Anesth Analg 99(1):182–187

    Article  Google Scholar 

  26. Bannon MP, Heller SF, Rivera M (2011) Anatomic considerations for central venous cannulation. Risk Manag Healthcare Policy 4:27–39

    Article  Google Scholar 

  27. Butler KL (2003) Effect of patient position on size and location of the subclavian vein for percutaneous puncture—invited critique. Arch Surg 138(9):1001

    Article  Google Scholar 

  28. LaBan MM, Zierenberg AT, Yadavalli S, Zaidan S (2011) Clavicle-induced narrowing of the thoracic outlet during shoulder abduction as imaged by computed tomographic angiography and enhanced by three-dimensional reformation. Am J Phys Med Rehabilit 90(7):572–578

    Article  Google Scholar 

  29. Lukish J, Valladares E, Rodriguez C, Patel K, Bulas D, Newman KD, Eichelberger MR (2002) Classical positioning decreases subclavian vein cross-sectional area in children. J Trauma 53(2):272–275

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Dr Evan Lim, DVM, MSc (Medical Art); Ms. Germaine Liew and Ms. Jillian Teo, Singapore Childhood Cancer Registry; Ms. Tan Sheng Hui, VIVA-KKH Paediatric Brain and Solid Tumor Program; Ms. Candy Choo, Department of Paediatric Surgery, KK Hospital.

Funding

This work was supported by the VIVA Foundation for Children with Cancer (AHP Loh), and Children’s Cancer Foundation.

Author information

Authors and Affiliations

  1. Flinders University School of Medicine, Flinders University, Adelaide, Australia

    Zhiyang Jace Lin

  2. Department of Paediatric Surgery, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    York Tien Lee & Amos Hong Pheng Loh

  3. Children’s Centre, Raffles Hospital, Singapore, Singapore

    Joyce Horng Yiing Chua

  4. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Rachel Wang & Vanessa Lee

  5. Department of Paediatric Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore

    Sue Mei Cheah

  6. Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore

    Seyed Ehsan Saffari

  7. Department of Paediatric Subspecialties Haematology Oncology Service, KK Women’s and Children’s Hospital, Singapore, Singapore

    Joyce Ching Mei Lam

Authors
  1. Zhiyang Jace Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. York Tien Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joyce Horng Yiing Chua
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rachel Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vanessa Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sue Mei Cheah
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Seyed Ehsan Saffari
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Joyce Ching Mei Lam
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Amos Hong Pheng Loh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amos Hong Pheng Loh.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lin, Z.J., Lee, Y.T., Chua, J.H.Y. et al. Evaluation of a Novel Bony Landmark-Based Method for Teaching Percutaneous Insertion of Subclavian Venous Catheters in Pediatric Patients. World J Surg 43, 2106–2113 (2019). https://doi.org/10.1007/s00268-019-04997-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-019-04997-x

Search

Navigation