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Chulalongkorn Medical Journal

Abstract

Background : Central venous catheterization (CVC) is an essential procedure incritical care of pediatric patients.Ultrasound-guided CVC shows highersuccess rate and lower complication rate than conventional anatomicallandmark guidance, and has been routinely performed in InterventionalRadiology unit, King Chulalongkorn Memorial Hospital (KCMH) for manyyears. Focusing on infant patient, we want to know the outcomes at ourhospital.Objective : To study the outcomes (success rate, complications and complicationrate) of using real-time ultrasound-guided CVC in infant patients atKCMH.Design : Retrospective study.Setting : Department of Radiology, Faculty of Medicine, Chulalongkorn University.Methods : We retrospectively reviewed medical records of 144 ultrasound-guidedCVC in 90 infants, that have been performed at the Intervention RadiologyUnit of KCMH between 2007 - 2010. We collected the patientdemographics, operative data, success rate, complications andcomplication rate. Subgroup analysis was created according to theirbody weight, history of previous catheterization, and duration ofcatheterization.Results : Of the total 144 catheterizations, the overall success rate was 97.9%.Acute complication was found in 4 procedures (2.8%). Late complicationwas found in 85 procedures (60.3%) most of which mostly wereinfection (58 procedures, 41.1%). There was no procedure-relatedmortality in the study. Following the subgroup analysis, significanthigher success rate were observed in the subgroup of infant>3,000 grams (100% versus 93% in infant ≤ 3,000 grams, P = 0.01). Thesubgroup analysis of the patients with history of previous catheterizationshowed more significant infectious complication (50.0% in previouscatheterizationversus 28.8% in new case, P = 0.01). Another subgroupanalysis showed higher infectious complication in the group of patientswith retaining catheter >7 days but the result was not statisticallysignificant (34.4% versus 43.1%, P = 0.38 in duration ≤ and > 7 days,respectively).Conclusion : Real-time ultrasound-guided CVC in infants had a high success rateand low acute complications. However, catheter-related infection isthe most common late complication, especially in infants with previouscatheterization.

Publisher

Faculty of Medicine, Chulalongkorn University

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1

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12

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