J Pediatr Intensive Care
DOI: 10.1055/s-0041-1735877
Letter to the Editor

Central Venous Catheter in Pediatric Intensive Care: Anatomical Landmark or Ultrasound Guide?

Rodolfo Rodríguez-Campos
1   Pediatric Emergency Hospital, Lima, Peru
,
Yris Elvira Falcon
2   Intensive Care Unit, Pediatric Emergency Hospital, Lima, Peru
,
2   Intensive Care Unit, Pediatric Emergency Hospital, Lima, Peru
› Author Affiliations
Funding None.

Central venous catheter (CVC) is a standard and necessary technique for managing children in intensive care units. CVC placement considers operator-specific factors such as training, skill, experience, methods for evaluating your location, and possible complications of the procedure. All of this leads to wide variability in CVC placement practices.[1]

Carmona et al reviewed the placement of 68 catheters in a Mexican hospital's pediatric service (48 through venipuncture and 20 through venesection), with 72% complications.[2] In a study performed in a Colombian university hospital, Rivera et al found that 100% of CVCs guided by real-time ultrasound were successful, compared with 87% of those conducted by anatomical landmarks.[3]

We presented the results of the CVC placement procedures at the Hospital de Emergencias Pediatricas. During 2019, 113 canalizations were performed, 76 by anatomical landmark, and 37 by ultrasound guidance. As much as 88.3% chose the internal jugular as the cannulation site, 9.2% subclavian, and 2.5% femoral. As much as 5.8% complications were observed, the main one being pneumothorax. The results show that the preferred CVC placement site was internal jugular, and the optimal position was superior vena cava—right atrium; similar data was obtained by Veten et al.[1] On the other hand, Veten et al[1] mentioned a greater use of ultrasound guidance, unlike our operators who prefer to perform direct puncture: almost 70% used anatomical landmark.

Our operators perform the procedure with minimal complications in both techniques (anatomical 5.2% vs. ultrasound 5.4%). Veten et al[1] showed that ultrasound use reduces the number of cannulation attempts; however, we did not find a significant difference between using a specific technique and number of attempts. A prospective investigation is needed to describe why our results do not agree with what was seen by Veten et al.



Publication History

Received: 05 April 2021

Accepted: 11 August 2021

Article published online:
16 September 2021

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  • References

  • 1 Veten A, Davis J, Kavanag R, Thomas N, Zurca A. Practice patterns of central venous catheter placement and confirmation in pediatric critical care. J Pediatr Intensive Care 2021; 10 (01) 1-84
  • 2 Carmona Moya AJ, Delgado Porras A, De La Puente Murguía R, Romero Montes V, Sámano Pozos JE. Complicaciones inmediatas de colocación de catéteres. Rev Mex Cir Ped. 2015; 19 (01) 28-34
  • 3 Rivera Tocancipáa D, Díaz Sánchez E, Montalvo Arce CA. Ultrasonido frente a referencias anatómicas: complicaciones inmediatas en la canalización de vía venosa central en menores de 18 años. Rev Esp Anestesiol Reanim 2018; 65 (07) 366-372