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Mechanical complications during central venous cannulations in pediatric patients

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Abstract

Objective

Identification of early mechanical complications (EMC) of central venous catheterizations (CVC) in pediatric patients and determination of EMC risk factors.

Design

Prospective observational study.

Setting

Pediatric intensive-care unit in a university hospital.

Patients and measurements

Eight-hundred and twenty-five CVC were performed in 546 patients. Age, weight, gender, mechanical ventilation, analgesia, resident CVC failure, CVC indication, admission diagnosis, emergency or scheduled procedure, type of catheter (diameter, lumen number), catheter final location, number of attempts, and EMC were recorded. Risk factors for EMC were determined by multivariate analysis.

Results

Median patient age was 22.0 months (0–216 months). CVC was an emergency procedure in 421 (51%) cases, scheduled in 336 (40.7%), and guide-wire exchanged in 68 (8.2%). There were 293 (35.5%) internal jugular, 116 (14.1%) subclavian, and 416 (50.4%) femoral catheters. CVC was performed by staff physicians in 35.8% cases, supervised residents in 43.4%, and staff after resident failure in 20.8%. 151 EMC occurred in 144 CVC (17.5%). The most commons EMC were arterial puncture (n = 60; 7.2%), catheter malposition (n = 39; 4.7%), arrhythmias (n = 19; 2.3%), and hematoma (n = 12; 1.4%). Resident failure to perform CVC (OR 2.53; CI 95% 1.53–4.16), high venous access (subclavian or jugular) (OR 1.91; CI 95% 1.26–2.88), and number of attempts (OR 1.10; CI 95% 1.03–1.17) were independently associated with EMC.

Conclusions

EMC of CVC were common in a teaching university hospital, but severe complications were very uncommon. Resident failure to perform CVC, high venous access, and number of attempts were independent risk factors for EMC of CVC.

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Acknowledgments

The authors gratefully acknowledge the assistance of the medical and nursing staff of the Hospital Universitario Central de Asturias PICU.

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Authors and Affiliations

  1. Paediatric Intensive Care Unit, Department of Paediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Celestino Villamil s/n 33006, Asturias, Oviedo, Spain

    Corsino Rey, Alberto Medina, Andrés Concha, Juan José Díaz, Sergio Menéndez, Marta Los Arcos & Juan Mayordomo-Colunga

  2. Paediatric Day Care Center, Servicio de Salud del Principado de Asturias, Asturias, Lugo de Llanera, Spain

    Francisco Álvarez

  3. Paediatric Day Care Center, Servicio de Salud del Principado de Asturias, El Cristo, Asturias, Oviedo, Spain

    Victoria De La Rua

Authors
  1. Corsino Rey
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  2. Francisco Álvarez
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  3. Victoria De La Rua
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  4. Alberto Medina
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  5. Andrés Concha
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  6. Juan José Díaz
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  7. Sergio Menéndez
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  8. Marta Los Arcos
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  9. Juan Mayordomo-Colunga
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Corresponding author

Correspondence to Corsino Rey.

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Rey, C., Álvarez, F., De La Rua, V. et al. Mechanical complications during central venous cannulations in pediatric patients. Intensive Care Med 35, 1438–1443 (2009). https://doi.org/10.1007/s00134-009-1534-0

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  • DOI: https://doi.org/10.1007/s00134-009-1534-0

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