Uses and complications of central venous catheters inserted in a pediatric emergency department

摘要

ObjectiveTo describe the incidence, indications, insertion sites, duration, and complications of central venous catheter (CVC) insertion in patients in a pediatric emergency department (ED).Methodscolon; DesignRetrospective chart review.SettingED of an urban pediatric teaching hospital.SubjectsPatients who had a CVC inserted in the ED from January 1992 to July 1997.ResultsDuring the 5.5-year study period, 121 patients were identified. Indications for insertion were cardiac/respiratory arrest in 20 patients (17percnt;), lack of peripheral vascular access in 78 (64percnt;), and inadequate peripheral vascular access in 23 (19percnt;). Presenting diagnoses included cardiac/respiratory arrest (20), dehydration (19), lower respiratory tract disease (15), seizure (15), sepsis (13), trauma (10), and other (29). Prior to the CVC insertion, 80 (66percnt;) patients had no venous access, 28 (23percnt;) had a peripheral intravenous catheter, and 13 (11percnt;) had an intraosseous needle. One hundred one (83percnt;) CVCs were inserted into the femoral vein, 12 (10percnt;) into the subclavian, 7 (6percnt;) into the internal jugular, and 1 (1percnt;) into an axillary vein. There were four reported complications requiring the CVC to be removed, and all occurred with femoral line placement. There were no long-term sequelae or life-threatening or limb-threatening complications (95percnt; CI equals; 0ndash;2.5percnt;).ConclusionsCentral venous catheterization, particularly using the femoral approach, appears to a safe method of obtaining central venous access in the critically ill infant, child, or young adult.