Real-time ultrasonography for placement of central venous catheters in children

A multi-institutional study

Lori A. Gurien, Martin L. Blakely, Robert T. Russell, Christian J. Streck, Adam M. Vogel, Elizabeth J. Renaud, Kate B. Savoie, Melvin S. Dassinger, Tate R. Nice, Jina Kim, Obinna O. Adibe, Bennett W. Calder, Charles M. Leys, Andrew P. Rogers, Daniel A. DeUgarte, Regan Williams, Shawn D. St. Peter, Dan W. Parrish, Jeffrey H. Haynes, David H. Rothstein & 2 others Howard C. Jen, Xinyu Tang

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Recommendations for the use of real-time ultrasonography for placement of central venous catheters in children are based on studies involving adults treated by nonsurgeons. Our purpose was to determine the frequency of use of real-time ultrasonography use by pediatric surgeons during central venous catheter placement, patient and procedure factors associated with real-time ultrasonography use, and adverse event rates. Methods Using data gathered from 14 institutions, we performed a retrospective cohort study of patients <18 years old who underwent central venous catheter placement. Patient demographics and operative details were collected. We used a logistic regression model to evaluate factors associated with real-time ultrasonography use. Results Real-time ultrasonography was used in 33% of attempts (N = 1,146). The subclavian vein (64%) was accessed preferentially for first site insertion. Real-time ultrasonography was less likely to be used for subclavian vein (odds ratio = 0.002; P < .0001) and more likely to be used when coagulopathy (international normalized ratio >1.5) was present (odds ratio = 11.1; P = .03). The rate of mechanical complications was 3.5%. Real-time ultrasonography use was associated with greater procedural success rates on first-site attempt, but also with a greater risk of hemothorax. Conclusion Pediatric surgeons access preferentially the subclavian vein for central venous access, yet are less likely to use real-time ultrasonography at this site. Real-time ultrasonography was superior to the landmark techniques for the first-site procedure success, yet was associated with greater rates of hemothorax. Prospective trials involving children treated by pediatric surgeons are needed to generate more definitive data.

Original languageEnglish (US)
Pages (from-to)1605-1611
Number of pages7
JournalSurgery (United States)
Volume160
Issue number6
DOIs
StatePublished - Dec 1 2016

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Central Venous Catheters
Ultrasonography
Hemothorax
Pediatrics
Subclavian Vein
Cohort Studies
Retrospective Studies
Odds Ratio
Surgeons

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Gurien, L. A., Blakely, M. L., Russell, R. T., Streck, C. J., Vogel, A. M., Renaud, E. J., ... Tang, X. (2016). Real-time ultrasonography for placement of central venous catheters in children: A multi-institutional study. Surgery (United States), 160(6), 1605-1611. https://doi.org/10.1016/j.surg.2016.05.019

Real-time ultrasonography for placement of central venous catheters in children : A multi-institutional study. / Gurien, Lori A.; Blakely, Martin L.; Russell, Robert T.; Streck, Christian J.; Vogel, Adam M.; Renaud, Elizabeth J.; Savoie, Kate B.; Dassinger, Melvin S.; Nice, Tate R.; Kim, Jina; Adibe, Obinna O.; Calder, Bennett W.; Leys, Charles M.; Rogers, Andrew P.; DeUgarte, Daniel A.; Williams, Regan; St. Peter, Shawn D.; Parrish, Dan W.; Haynes, Jeffrey H.; Rothstein, David H.; Jen, Howard C.; Tang, Xinyu.

In: Surgery (United States), Vol. 160, No. 6, 01.12.2016, p. 1605-1611.

Research output: Contribution to journalArticle

Gurien, LA, Blakely, ML, Russell, RT, Streck, CJ, Vogel, AM, Renaud, EJ, Savoie, KB, Dassinger, MS, Nice, TR, Kim, J, Adibe, OO, Calder, BW, Leys, CM, Rogers, AP, DeUgarte, DA, Williams, R, St. Peter, SD, Parrish, DW, Haynes, JH, Rothstein, DH, Jen, HC & Tang, X 2016, 'Real-time ultrasonography for placement of central venous catheters in children: A multi-institutional study', Surgery (United States), vol. 160, no. 6, pp. 1605-1611. https://doi.org/10.1016/j.surg.2016.05.019
Gurien, Lori A. ; Blakely, Martin L. ; Russell, Robert T. ; Streck, Christian J. ; Vogel, Adam M. ; Renaud, Elizabeth J. ; Savoie, Kate B. ; Dassinger, Melvin S. ; Nice, Tate R. ; Kim, Jina ; Adibe, Obinna O. ; Calder, Bennett W. ; Leys, Charles M. ; Rogers, Andrew P. ; DeUgarte, Daniel A. ; Williams, Regan ; St. Peter, Shawn D. ; Parrish, Dan W. ; Haynes, Jeffrey H. ; Rothstein, David H. ; Jen, Howard C. ; Tang, Xinyu. / Real-time ultrasonography for placement of central venous catheters in children : A multi-institutional study. In: Surgery (United States). 2016 ; Vol. 160, No. 6. pp. 1605-1611.
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abstract = "Background Recommendations for the use of real-time ultrasonography for placement of central venous catheters in children are based on studies involving adults treated by nonsurgeons. Our purpose was to determine the frequency of use of real-time ultrasonography use by pediatric surgeons during central venous catheter placement, patient and procedure factors associated with real-time ultrasonography use, and adverse event rates. Methods Using data gathered from 14 institutions, we performed a retrospective cohort study of patients <18 years old who underwent central venous catheter placement. Patient demographics and operative details were collected. We used a logistic regression model to evaluate factors associated with real-time ultrasonography use. Results Real-time ultrasonography was used in 33{\%} of attempts (N = 1,146). The subclavian vein (64{\%}) was accessed preferentially for first site insertion. Real-time ultrasonography was less likely to be used for subclavian vein (odds ratio = 0.002; P < .0001) and more likely to be used when coagulopathy (international normalized ratio >1.5) was present (odds ratio = 11.1; P = .03). The rate of mechanical complications was 3.5{\%}. Real-time ultrasonography use was associated with greater procedural success rates on first-site attempt, but also with a greater risk of hemothorax. Conclusion Pediatric surgeons access preferentially the subclavian vein for central venous access, yet are less likely to use real-time ultrasonography at this site. Real-time ultrasonography was superior to the landmark techniques for the first-site procedure success, yet was associated with greater rates of hemothorax. Prospective trials involving children treated by pediatric surgeons are needed to generate more definitive data.",
author = "Gurien, {Lori A.} and Blakely, {Martin L.} and Russell, {Robert T.} and Streck, {Christian J.} and Vogel, {Adam M.} and Renaud, {Elizabeth J.} and Savoie, {Kate B.} and Dassinger, {Melvin S.} and Nice, {Tate R.} and Jina Kim and Adibe, {Obinna O.} and Calder, {Bennett W.} and Leys, {Charles M.} and Rogers, {Andrew P.} and DeUgarte, {Daniel A.} and Regan Williams and {St. Peter}, {Shawn D.} and Parrish, {Dan W.} and Haynes, {Jeffrey H.} and Rothstein, {David H.} and Jen, {Howard C.} and Xinyu Tang",
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T1 - Real-time ultrasonography for placement of central venous catheters in children

T2 - A multi-institutional study

AU - Gurien, Lori A.

AU - Blakely, Martin L.

AU - Russell, Robert T.

AU - Streck, Christian J.

AU - Vogel, Adam M.

AU - Renaud, Elizabeth J.

AU - Savoie, Kate B.

AU - Dassinger, Melvin S.

AU - Nice, Tate R.

AU - Kim, Jina

AU - Adibe, Obinna O.

AU - Calder, Bennett W.

AU - Leys, Charles M.

AU - Rogers, Andrew P.

AU - DeUgarte, Daniel A.

AU - Williams, Regan

AU - St. Peter, Shawn D.

AU - Parrish, Dan W.

AU - Haynes, Jeffrey H.

AU - Rothstein, David H.

AU - Jen, Howard C.

AU - Tang, Xinyu

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Background Recommendations for the use of real-time ultrasonography for placement of central venous catheters in children are based on studies involving adults treated by nonsurgeons. Our purpose was to determine the frequency of use of real-time ultrasonography use by pediatric surgeons during central venous catheter placement, patient and procedure factors associated with real-time ultrasonography use, and adverse event rates. Methods Using data gathered from 14 institutions, we performed a retrospective cohort study of patients <18 years old who underwent central venous catheter placement. Patient demographics and operative details were collected. We used a logistic regression model to evaluate factors associated with real-time ultrasonography use. Results Real-time ultrasonography was used in 33% of attempts (N = 1,146). The subclavian vein (64%) was accessed preferentially for first site insertion. Real-time ultrasonography was less likely to be used for subclavian vein (odds ratio = 0.002; P < .0001) and more likely to be used when coagulopathy (international normalized ratio >1.5) was present (odds ratio = 11.1; P = .03). The rate of mechanical complications was 3.5%. Real-time ultrasonography use was associated with greater procedural success rates on first-site attempt, but also with a greater risk of hemothorax. Conclusion Pediatric surgeons access preferentially the subclavian vein for central venous access, yet are less likely to use real-time ultrasonography at this site. Real-time ultrasonography was superior to the landmark techniques for the first-site procedure success, yet was associated with greater rates of hemothorax. Prospective trials involving children treated by pediatric surgeons are needed to generate more definitive data.

AB - Background Recommendations for the use of real-time ultrasonography for placement of central venous catheters in children are based on studies involving adults treated by nonsurgeons. Our purpose was to determine the frequency of use of real-time ultrasonography use by pediatric surgeons during central venous catheter placement, patient and procedure factors associated with real-time ultrasonography use, and adverse event rates. Methods Using data gathered from 14 institutions, we performed a retrospective cohort study of patients <18 years old who underwent central venous catheter placement. Patient demographics and operative details were collected. We used a logistic regression model to evaluate factors associated with real-time ultrasonography use. Results Real-time ultrasonography was used in 33% of attempts (N = 1,146). The subclavian vein (64%) was accessed preferentially for first site insertion. Real-time ultrasonography was less likely to be used for subclavian vein (odds ratio = 0.002; P < .0001) and more likely to be used when coagulopathy (international normalized ratio >1.5) was present (odds ratio = 11.1; P = .03). The rate of mechanical complications was 3.5%. Real-time ultrasonography use was associated with greater procedural success rates on first-site attempt, but also with a greater risk of hemothorax. Conclusion Pediatric surgeons access preferentially the subclavian vein for central venous access, yet are less likely to use real-time ultrasonography at this site. Real-time ultrasonography was superior to the landmark techniques for the first-site procedure success, yet was associated with greater rates of hemothorax. Prospective trials involving children treated by pediatric surgeons are needed to generate more definitive data.

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