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J Pediatr Intensive Care 2022; 11(03): 254-258
DOI: 10.1055/s-0041-1723949
Original Article

Practice Patterns of Central Venous Catheter Placement and Confirmation in Pediatric Critical Care

Ahmed Veten 
1   Department of Pediatric Critical Care, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
,
Joshua Davis 
2   Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
,
Robert Kavanagh 
3   Department of Pediatrics & Critical Care Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
,
Neal Thomas 
4   Department of Pediatrics and Public Health Sciences, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
,
Adrian Zurca 
5   Department of Pediatric Critical Care, Pediatrics, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
› Author Affiliations Funding The study was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grants UL1 TR002014 and UL1 TR00045.
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Abstract

Optimal practices for the placement of central venous catheters (CVCs) in critically ill children are unclear. This study describes the clinical practice of pediatric critical care medicine (PCCM) providers regarding CVC placement, including site selection, confirmation practices and assessment of complications. Two-hundred fourteen PCCM providers responded to an electronic survey, including 170 (79%) attending physicians, 30 (14%) fellow physicians, and 14 (7%) advanced practice providers. PCCM providers most commonly place internal jugular (IJ) and femoral CVCs, with subclavian CVCs and peripherally inserted central catheters (PICCs) placed less commonly (IJ 99%, femoral 95%, subclavian 40%, PICC 19%). The IJ is the most preferred site (128/214 (60%)); decreased infection risk is the most common reason for preferring this site. The subclavian is the least preferred site (150/214 [70%]) due to concern for increased risk of complications (51%) and personal discomfort with the procedure (49%). One-hundred twenty-six (59%) of respondents reported receiving formal ultrasound (US) or echocardiography training. Respondents reported using dynamic US guidance for placement in 90% of IJ, 86% of PICC, 78% of femoral, and 12% of subclavian CVCs. Plain radiography (X-ray) was the most preferred modality for confirming CVC tip position (85%) compared with US (9%) and no imaging (5%). Most providers reported using X-ray to evaluate for pneumothorax following upper extremity CVC placement, with only 5% reporting use of US and none relying on physical exam alone. This study demonstrates wide variability in PCCM providers' CVC placement practices. Potential training gaps exist for placement of subclavian catheters and use of US.

Keywords

pediatric critical care - vascular access - central venous catheter - ultrasound - pneumothorax - education


Publication History

Received: 25 November 2020

Accepted: 04 January 2021

Article published online:
17 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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