Advertisement

Pediatric Radiology

, Volume 47, Issue 12, pp 1682–1687 | Cite as

Single-stick tunneled central venous access using the jugular veins in infants weighing less than 5 kg

  • Will S. Lindquester
  • C. Matthew Hawkins
  • Eric J. Monroe
  • Anne E. Gill
  • Giridhar M. Shivaram
  • F. Glen Seidel
  • Matthew P. Lungren
Original Article

Abstract

Background

Despite the demonstrated feasibility of the single-stick technique in the femoral vein, its use in neonates and infants for placing central lines in internal and external jugular veins has not been reported.

Objective

Describe and assess the safety and efficacy of tunneled jugular central venous catheter placement performed under ultrasound (US) and fluoroscopic guidance in neonates and infants weighing <5 kg using the single-stick technique at three tertiary pediatric hospitals.

Materials and methods

Thirty-three children weighing less than 5 kg received tunneled central venous access in either internal or external jugular veins using the single-stick technique. Patient history, procedural records and clinical follow-up documents were retrospectively reviewed. Complication rates were compared to those of 41 patients receiving single-stick femoral central lines.

Results

Technical complications occurred during one (3.0%) jugular placement with the patient having a failed right-side attempt with subsequent successful left-side placement. The catheters did not last the entire course of treatment in three (9.1%) patients with jugular lines. One patient had the catheter removed due to concern for infection, one catheter was accidentally removed during dressing changes, and one catheter was displaced and subsequently exchanged. Of patients receiving femoral central lines, 1 (2.4%) had a technical complication and 5 catheters (12.2%) did not last the entire course of treatment.

Conclusion

The placement of tunneled central venous catheters in neonates/infants <5 kg is safe and technically feasible using the internal/external jugular vein via the single-stick technique. By theoretically reducing the risks of catheter infection by avoiding the diaper area and thrombosis by using larger veins, it may be preferable in certain patient populations.

Keywords

Central venous catheter Femoral vein Infants Interventional radiology Jugular vein Ultrasound Venous access 

Notes

Compliance with ethical standards

Conflicts of interest

None

References

  1. 1.
    Vo JN, Hoffer FA, Shaw DW (2010) Techniques in vascular and interventional radiology: pediatric central venous access. Tech Vasc Interv Radiol 13:250–257CrossRefPubMedGoogle Scholar
  2. 2.
    Greenberg RG, Cochran KM, Smith PB (2015) Effect of catheter dwell time on risk of central line–associated bloodstream infection in infants. Pediatrics 136:1080–1086CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Johnson KN, Thomas T, Grove J, Jarboe MD (2016) Insertion of peripherally inserted central catheters in neonates less than 1.5 kg using ultrasound guidance. Pediatr Surg Int 32:1053CrossRefPubMedGoogle Scholar
  4. 4.
    Evans RS, Sharp JH, Linford LH et al (2010) Risk of symptomatic DVT associated with peripherally inserted central catheters. Chest 138:803–810CrossRefPubMedGoogle Scholar
  5. 5.
    Grove JR, Pevec WC (2000) Venous thrombosis related to peripherally inserted central catheters. J Vasc Interv Radiol 11:837–840CrossRefPubMedGoogle Scholar
  6. 6.
    Menéndez JJ, Verdú C, Calderón B et al (2016) Incidence and risk factors of superficial and deep vein thrombosis associated with peripherally inserted central catheters in children. J Thromb Haemost 14:2158–2168CrossRefPubMedGoogle Scholar
  7. 7.
    Schummer W, Schummer C, Rose N et al (2007) Mechanical complications and malpositions of central venous cannulations by experienced operators. Intensive Care Med 33:1055–1059CrossRefPubMedGoogle Scholar
  8. 8.
    Bruzoni M, Slater BJ, Wall J et al (2013) A prospective randomized trial of ultrasound- vs landmark-guided central venous access in the pediatric population. J Am Coll Surg 216:939–943CrossRefPubMedGoogle Scholar
  9. 9.
    Subramanian S, Moe DC, Vo JN (2013) Ultrasound-guided tunneled lower extremity peripherally inserted central catheter placement in pnfants. J Vasc Interv Radiol 12:1910–1913CrossRefGoogle Scholar
  10. 10.
    Gaballah M, Krishnamurthy G, Berman JI et al (2015) Lower extremity vascular access in neonates and infants: a single institutional experience. J Vasc Interv Radiol 26:1660–1668CrossRefPubMedGoogle Scholar
  11. 11.
    Freeman JJ, Gadepalli SK, Siddiqui SM et al (2015) Improving central line infection rates in the neonatal intensive care unit: effect of hospital location, site of insertion, and implementation of catheter-associated bloodstream infection protocols. J Pediatr Surg 50:860–863CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Matsui Y, Shimatani M, Kuzuhara K et al (2015) Three-year prospective, observational study of central line-associated bloodstream infections in a 600-bed Japanese acute care hospital. Am J Infect Control 43:494–498CrossRefPubMedGoogle Scholar
  13. 13.
    Tsai MH, Lien R, Wang JW et al (2009) Complication rates with central venous catheters inserted at femoral and non-femoral sites in very low birth weight infants. Pediatr Infect Dis J 28:966–970CrossRefPubMedGoogle Scholar
  14. 14.
    Pronovost P (2008) Interventions to decrease catheter-related bloodstream infections in the ICU: the keystone intensive care unit project. Am J Infect Control 36(Suppl):S171.e1–S175Google Scholar
  15. 15.
    Sayin MM, Mercan A, Koner O et al (2008) Internal jugular vein diameter in pediatric patients: are the J-shaped guidewire diameters bigger than internal jugular vein? An evaluation with ultrasound. Paediatr Anaesth 18:745–751CrossRefPubMedGoogle Scholar
  16. 16.
    Contractor SG, Phatak TD, Klyde D et al (2009) Single-incision technique for tunneled central venous access. J Vasc Interv Radiol 20:1052–1058CrossRefPubMedGoogle Scholar
  17. 17.
    Glenn BJ (2007) Single-incision method for the placement of an implantable chest port or a tunneled catheter. J Vasc Interv Radiol 18:137–140CrossRefPubMedGoogle Scholar
  18. 18.
    Gaballah M, Krishnamurthy G, Keller MS et al (2014) Single-incision technique for placement of tunneled internal jugular vein vascular access in children. Pediatr Radiol 44:1004–1010CrossRefPubMedGoogle Scholar
  19. 19.
    Lungren M, Pabon-Ramos WM (2013) Single-incision technique for placing femoral tunneled central venous catheters in infants. J Vasc Interv Radiol 24:755–756CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Will S. Lindquester
    • 1
  • C. Matthew Hawkins
    • 1
    • 2
  • Eric J. Monroe
    • 3
  • Anne E. Gill
    • 1
    • 2
  • Giridhar M. Shivaram
    • 3
  • F. Glen Seidel
    • 4
  • Matthew P. Lungren
    • 4
  1. 1.Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided MedicineEmory University School of MedicineAtlantaUSA
  2. 2.Department of RadiologyChildren’s Healthcare of AtlantaAtlantaUSA
  3. 3.Department of Radiology, Seattle Children’s HospitalUniversity of Washington School of MedicineSeattleUSA
  4. 4.Department of Radiology, Lucile Packard Children’s HospitalStanford University School of MedicineStanfordUSA

Personalised recommendations