Utility of real-time ultrasound-guided central venous catheterization in infant patients in interventional radiology at KCMH

Abstract

Background : Central venous catheterization (CVC) is an essential procedure in critical care of pediatric patients.Ultrasound-guided CVC shows higher success rate and lower complication rate than conventional anatomical landmark guidance, and has been routinely performed in Interventional Radiology unit, King Chulalongkorn Memorial Hospital (KCMH) for many years. Focusing on infant patient, we want to know the outcomes at our hospital.

Objective : To study the outcomes (success rate, complications and complication rate) of using real-time ultrasound-guided CVC in infant patients at KCMH.

Design : Retrospective study.

Setting : Department of Radiology, Faculty of Medicine, Chulalongkorn University.

Methods : We retrospectively reviewed medical records of 144 ultrasound-guided CVC in 90 infants, that have been performed at the Intervention Radiology Unit of KCMH between 2007 - 2010. We collected the patient demographics, operative data, success rate, complications and complication rate. Subgroup analysis was created according to their body weight, history of previous catheterization, and duration of catheterization.

Results : Of the total 144 catheterizations, the overall success rate was 97.9%. Acute complication was found in 4 procedures (2.8%). Late complication was found in 85 procedures (60.3%) most of which mostly were infection (58 procedures, 41.1%). There was no procedure-related mortality in the study. Following the subgroup analysis, significant higher success rate were observed in the subgroup of infant >3,000 grams (100% versus 93% in infant ≤ 3,000 grams, P = 0.01). The subgroup analysis of the patients with history of previous catheterization showed more significant infectious complication (50.0% in previous catheterizationversus 28.8% in new case, P = 0.01). Another subgroup analysis showed higher infectious complication in the group of patients with retaining catheter >7 days but the result was not statistically significant (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 rate and low acute complications. However, catheter-related infection is the most common late complication, especially in infants with previous catheterization.