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Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit*

Froehlich, Curt D. MD; Rigby, Mark R. MD, PhD, FAAP; Rosenberg, Eli S. BS; Li, Ruosha BS; Roerig, Pei-Ling J. BS, CCRC; Easley, Kirk A. MS; Stockwell, Jana A. MD, FAAP, FCCM

doi: 10.1097/CCM.0b013e31819b570e
Pediatric Critical Care

Objective: To determine whether ultrasound (US) increases successful central venous catheter (CVC) placement, decreases site attempts, and decreases CVC placement complications.

Design and Setting: A prospective observational cohort study evaluating a transition by the Pediatric Critical Care Medicine service to US-guided CVC placement. Medical and surgical patients in a 21-bed quaternary multidisciplinary pediatric intensive care unit had CVCs placed by attendings, fellows, residents, and a nurse practitioner.

Patients: Ninety-three patients were prospectively enrolled into the landmark (LM) group and 119 into the US group.

Interventions: After collection of prospective LM data, training with US guidance was provided. CVCs were subsequently placed with US guidance.

Measurements and Main Results: Operator information, disease process, emergent/routine, sites attempted, and complications were recorded. Procedure time was from initial skin puncture to guidewire placement. There was no difference overall in success rates (88.2% LM vs. 90.8% US, p = 0.54) or time to successful placement (median seconds 269 LM vs. 150 US, p = 0.14) between the two groups. Median number of attempts were fewer with US for all CVCs attempted (3 vs. 1, p < 0.001) as were attempts at >1 anatomical site (20.7% LM vs. 5.9% US, p = 0.001). Use of US was associated with fewer inadvertent artery punctures (8.5% vs. 19.4%, p = 0.03). Time to successful placement by residents was decreased with US (median 919 seconds vs. 405 seconds, p = 0.02). More internal jugular CVCs were placed during the US period than during the LM period (13.4% vs. 2.1%).

Conclusions: US-guided CVC placement in children is associated with decreased number of anatomical sites attempted and decreased number of attempts to gain placement. Time to placement by residents was decreased with US, but not the time to placement by other operators. US guidance increased the use of internal jugular catheter placement and decreased artery punctures. US guidance did not improve success rates.

From the Department of Pediatrics (CDF), Division of Critical Care Medicine, University of Texas Health Science Center, San Antonio, TX; Department of Pediatrics (MRR, JAS), Division of Pediatric Critical Care Medicine, Emory University School of Medicine; Department of Critical Care Medicine (MRR, P-LJR, JAS), Children’s Healthcare of Atlanta at Egleston, Atlanta, GA; Department of Surgery (MRR), Emory Transplant Center, Emory University School of Medicine; and Department of Biostatistics and Bioinformatics (ESR, RL, KAE), Emory University, Rollins School of Public Health.

Supported, in part, by independent funds from the Department of Critical Care Medicine at Children’s Healthcare of Atlanta at Egleston.

The authors have not disclosed any potential conflicts of interest.

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© 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins