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Supraclavicular catheterization of the brachiocephalic vein: a way to prevent or reduce catheter maintenance-related complications in children

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Abstract

Placement of a central venous catheter (CVC) in the brachiocephalic vein (BCV) via the ultrasound (US)-guided supraclavicular approach was recently described in children. We aimed to determine the CVC maintenance-related complications at this site compared to the others (i.e., the femoral, the subclavian, and the jugular). We performed a retrospective data collection of prospectively registered data on CVC in young children hospitalized in a pediatric intensive care unit (PICU) during a 4-year period (May 2011 to May 2015). The primary outcome was a composite of central line-associated bloodstream infection (CLABSI) and deep-vein thrombosis (CLAT) according to the CVC site. Two hundred and twenty-five children, with respective age and weight of 7.1 (1.3–40.1) months and 7.7 (3.6–16) kg, required 257 CVCs, including 147 (57.2%) inserted in the BCV. The risk of the primary outcome was lower in the BCV than in the other sites (5.4 vs 16.4%; OR: 0.29; 95% CI: 0.12–0.70; p = 0.006). CLABSI incidence density rate (2.8 vs 8.96 per 1000 catheter days, p < 0.001) and CLAT incidence rate (2.7 vs 10%, p = 0.016) were also lower at this site. Conclusion: BCV catheterization via the US-guided supraclavicular approach may decrease CVC maintenance-related complications in children hospitalized in a PICU.

What is Known:

• Placement of a central venous catheter (CVC) in children is associated with mechanical risks during insertion, and with infectious and thrombotic complications during its maintenance.

• Ultrasound (US)-guided supraclavicular catheterization of the brachiocephalic vein (BCV) is feasible in infants and children.

What is New:

• This observational study suggested that BCV catheterization via the US-guided supraclavicular approach was associated with a lower risk of CVC insertion and maintenance-related complications, compared with the other catheterization sites.

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Abbreviations

BCV:

brachiocephalic vein

CDC:

Centers for Disease Control and Prevention

CLABSI:

central line-associated bloodstream infection

CLAT:

central line-associated deep vein thrombosis

CVC:

central venous catheter

NHSN:

National Healthcare Safety Network

PICU:

pediatric intensive care unit

PIM:

pediatric index of mortality

US:

ultrasound

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Author information

Authors and Affiliations

  1. Pediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France

    Flora Habas, Julien Baleine, Christophe Milési, Clémentine Combes & Gilles Cambonie

  2. Department of Bacteriology, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France

    Marie-Noëlle Didelot

  3. Department of Hospital Infection Control, Saint Eloi Hospital, Montpellier University Hospital Center, Montpellier, France

    Sara Romano-Bertrand, Delphine Grau & Sylvie Parer

  4. Department of Pediatric Radiology, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France

    Catherine Baud

  5. Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France

    Gilles Cambonie

Authors
  1. Flora Habas
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  2. Julien Baleine
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  10. Gilles Cambonie
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Contributions

Flora Habas Julien Baleine and Gilles Cambonie conceived and designed the study, contributed to the search of published work, data acquisition, data interpretation, drafted, and finalized the report.

Christophe Milési and Clémentine Combes performed data analysis, contributed to data interpretation, and critically revised the report.

Marie-Noëlle Didelot, Sara Romano-Bertrand, Delphine Grau, and Sylvie Aubas critically revised the report and made substantial contributions on the final manuscript.

Catherine Baud contributed to data acquisition and critically revised the report.

Corresponding author

Correspondence to Gilles Cambonie.

Ethics declarations

The study was approved by the local ethics committee.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Communicated by Patrick Van Reempts

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Habas, F., Baleine, J., Milési, C. et al. Supraclavicular catheterization of the brachiocephalic vein: a way to prevent or reduce catheter maintenance-related complications in children. Eur J Pediatr 177, 451–459 (2018). https://doi.org/10.1007/s00431-017-3082-x

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  • DOI: https://doi.org/10.1007/s00431-017-3082-x

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