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Abstract

Background: Complications correlated with central venous catheterization (CVC) are common and risky in pediatric patients leading to increased morbidity.
Objective: To study the CVC-related complications concerning different access sites and ultrasound (US)-guided catheterization.
Methods: This retrospective study was conducted in a tertiary care teaching institution in central India. Children admitted to pediatric and pediatric surgical intensive care units between 2014 and 2018 requiring CVCs were included in this study. Data was recorded for demographic details, diagnosis, indications, techniques of CVC insertion, and complications associated with CVC. The Central line-associated bloodstream infections (CLABSIs) were defined based on a positive CVC tip culture with a positive blood culture.
Results: 615 CVCs were inserted into 520 patients in children aged 1 month to 14 years. US-guided catheterization was performed only in 15.61% (96) cases, and the landmark method was used in 84.39% (519) of the CVC insertions. The femoral vein was the most accessed site (54.79%) followed by the internal jugular (36.59%), and subclavian vein (8.62%). The median CVC dwell time was 5 (3–8) days. The success rate of CVC insertion in the first attempt (US 53% vs. LM 28%; p<0.05) and overall success (US 89% vs. LM 76%; p<0.05) was significantly higher in the US group. Although higher complications were observed in the femoral vein, the difference was insignificant (p>0.05).
Conclusion: The study’s findings were conclusive that US guidance reduces complications significantly and makes the procedure more efficient. No significant correlation was observed between the site of insertion and complications.