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Lo HY, Fung KFK, Yam F, Leung Y, Liu A, Cheng KK, Cho D, Kan EYL, Chao N. Height-based formulas for predicting intravascular length of tunnelled neck central venous catheter in paediatric population. Pediatr Surg Int 2023; 39:262. [PMID: 37668756 DOI: 10.1007/s00383-023-05537-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Central venous catheter (CVC) placement is commonly performed in children. We aim to develop simple formulas to predict CVC intravascular length to minimise radiation exposure associated with the procedure. METHODS 124 paediatric patients who received tunnelled neck CVCs and subsequent CT thorax at Hong Kong Children's Hospital from January 2020 to July 2022 were reviewed retrospectively. Formula development cohorts were subdivided by insertion sites-9 right external jugular vein (REJV), 41 right internal jugular vein (RIJV), 14 left external jugular vein (LEJV), 10 left internal jugular vein (LIJV). Using measurements from CT by two radiologists, formulas predicting the CVC intravascular length based on height and insertion sites were developed using a linear regression model. These formulas were tested with validation cohorts (10 randomly selected cases in REJV and RIJV groups respectively). Validation cohorts were not available for LEJV and LIJV groups due to small sample sizes. RESULT The goodness-of-fit (R^2) of all formulas are above 0.8. In the validation cohorts, the REJV formula was predictive of intravascular CVC length within 1 cm in 70% of CVC with mean absolute difference of 0.63 cm (SD 0.48 cm), and the RIJV formula was predictive of intravascular CVC length within 1 cm in 80% of CVC with mean absolute difference of 0.67 cm (SD 0.53 cm). CONCLUSION Intravascular CVC length can be estimated using simple formulas based on height and insertion sites. Further prospective validation of the LEJV and LIJV formulas is needed.
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Affiliation(s)
- H Y Lo
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong SAR, China.
| | - K F K Fung
- Department of Radiology, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - F Yam
- Department of Paediatric Surgery, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Y Leung
- Department of Paediatric Surgery, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - A Liu
- Department of Paediatrics, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - K K Cheng
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong SAR, China
| | - D Cho
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong SAR, China
| | - E Y L Kan
- Department of Radiology, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - N Chao
- Department of Paediatric Surgery, Hong Kong Children's Hospital, Hong Kong SAR, China
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2
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Uzumcugil F. Distance that the catheter covers from skin to the vein using the US-guided in-plane technique: The impact of footprint of the probe and depth of the vein. J Vasc Access 2023; 24:1218-1220. [PMID: 35001711 DOI: 10.1177/11297298211068301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Employing the in-plane technique in infants the footprint of the ultrasound probe should be considered along with the depth of the vein, and the angle between the needle and the face of the probe, which is crucial in optimization of the visibility of the needle in the beam. Three different ultrasound probes are evaluated for different depths of vein. The hockey-stick probe provided a shorter minimum distance while maintaining the angle between the needle and the face of the probe within an optimal range for visualization of the needle in the beam, supporting its recommendation for infants with regard to its frequency and physical size.
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Affiliation(s)
- Filiz Uzumcugil
- Department of Anesthesiology and Reanimation, Hacettepe University School of Medicine, Ankara, Turkey
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3
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Falay D, Schindler E, Mikus M, Boulos A, Sylvia S, Alina S, Torsten B. Ultrasound-guided supraclavicular cannulation of left brachiocephalic versus right internal jugular vein: Comparative analysis of central venous catheter-associated complications. Paediatr Anaesth 2023; 33:219-228. [PMID: 36350095 DOI: 10.1111/pan.14600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/13/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
AIMS Central venous catheters are essential for the management of pediatric cardiac surgery patients. Recently, an ultrasound-guided access via a supraclavicular approach to the brachiocephalic vein has been described. Central venous catheters are associated with a relevant number of complications in pediatric patients. In this study, we evaluated the frequency of complications of left brachiocephalic vein access compared with right internal jugular vein standard access in children undergoing cardiac surgery. METHODS Retrospective analysis of all pediatric cases at our tertiary care university hospital over a two-year period receiving central venous catheters for cardiac surgery. PRIMARY ENDPOINT Frequency of complications associated with central venous catheters inserted via the left brachiocephalic vein vs. right internal jugular vein. Complications were defined as: chylothorax, deep vein thrombosis, sepsis, or delayed chest closure. Secondary endpoints: Evaluation of the insertion depth of the catheter using a height-based formula without adjustment for side used. RESULTS Initially, 504 placed catheters were identified. Following inclusion and exclusion criteria, 480 placed catheters remained for final analysis. Overall complications were reported in 68/480 (14.2%) cases. There was no difference in the frequency of all complications in the left brachiocephalic vein vs. the right internal jugular vein group (15.49% vs. 13.65%; OR = 1.16 [0.64; 2.07]), nor was there any difference considering the most relevant complications chylothorax (7.7% vs. 8.6%; OR = 0.89 [0.39; 1.91]) and thrombosis (5.6% vs. 4.5%; OR = 1.28 [0.46; 3.31]). The mean deviation from the optimal insertion depth was left brachiocephalic vein vs. right internal jugular vein 5.38 ± 13.6 mm and 4.94 ± 15.1 mm, respectively. CONCLUSIONS Among children undergoing cardiac surgery, there is no significant difference between the supraclavicular approach to the left brachiocephalic vein and the right internal jugular vein regarding complications. For both approaches, a universal formula can be used to determine the correct insertion depth.
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Affiliation(s)
- Diyar Falay
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Ehrenfried Schindler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Marian Mikus
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Asfour Boulos
- Department of Congenital Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Schroth Sylvia
- Department of Congenital Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Schenk Alina
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Baehner Torsten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.,Department of Anesthesiology and Intensive Care Medicine, Stiftshospital Andernach, Andernach, Germany
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Moisa SM, Spoiala EL, Trandafir LM, Butnariu LI, Miron IC, Ciobanu A, Mocanu A, Ivanov A, Ciongradi CI, Sarbu I, Ciubara A, Rusu CD, Luca AC, Burlacu A. Unusual Association of Diamond-Blackfan Anemia and Severe Sinus Bradycardia in a Six-Month-Old White Infant: A Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:362. [PMID: 36837563 PMCID: PMC9964496 DOI: 10.3390/medicina59020362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/01/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023]
Abstract
Diamond-Blackfan anemia is a rare (6-7 million live births), inherited condition manifesting as severe anemia due to the impaired bone marrow production of red blood cells. We present the unusual case of a six month old infant with a de novo mutation of the RPS19 gene causing Diamond-Blackfan anemia who additionally suffers from severe sinus bradycardia. The infant was diagnosed with this condition at the age of four months; at the age of 6 months, she presents with severe anemia causing hypoxia which, in turn, caused severe dyspnea and polypnea, which had mixed causes (hypoxic and infectious) as the child was febrile. After correction of the overlapping diarrhea, metabolic acidosis, and severe anemia (hemoglobin < 3 g/dL), she developed severe persistent sinus bradycardia immediately after mild sedation (before central venous catheter insertion), not attributable to any of the more frequent causes, with a heart rate as low as 49 beats/min on 24 h Holter monitoring, less than the first percentile for age, but with a regular QT interval and no arrhythmia. The echocardiogram was unremarkable, showing a small interatrial communication (patent foramen ovale with left-to-right shunting), mild left ventricular hypertrophy, normal systolic and diastolic function, and mild tricuspid regurgitation. After red cell transfusion and appropriate antibiotic and supportive treatment, the child's general condition improved dramatically but the sinus bradycardia persisted. We consider this a case of well-tolerated sinus bradycardia and foresee a good cardiologic prognosis, while the hematologic prognosis remains determined by future corticoid response, treatment-related complications and risk of leukemia.
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Affiliation(s)
- Stefana Maria Moisa
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
| | - Elena-Lia Spoiala
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Laura Mihaela Trandafir
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
| | - Lacramioara Ionela Butnariu
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
- Genetics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ingrith-Crenguta Miron
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
| | - Antonela Ciobanu
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
| | - Adriana Mocanu
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
| | - Anca Ivanov
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
| | - Carmen Iulia Ciongradi
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
- 2nd Department of Surgery—Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ioan Sarbu
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
- 2nd Department of Surgery—Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Anamaria Ciubara
- Faculty of Medicine, “Dunarea de Jos” University of Medicine and Pharmacy, 800008 Galati, Romania
| | - Carmen Daniela Rusu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alina Costina Luca
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
| | - Alexandru Burlacu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, 700503 Iasi, Romania
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5
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A CT scan-based formula for predicting central venous catheter length in pediatric patients. Pediatr Surg Int 2022; 38:1335-1340. [PMID: 35849175 DOI: 10.1007/s00383-022-05165-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Placement of a central venous catheter (CVC) is the most commonly performed pediatric procedure. This study aims to develop simple formulas to calculate intravascular length of CVCs prior to insertion to minimize reliance on fluoroscopic and radiographic imaging, which may not be uniformly available. METHODS We performed a single-institution, retrospective review of 115 pediatric patients who received both CVC placement and computed tomography (CT) imaging of the chest within 3 months of the procedure. Using measurements from the CT imaging, formulas calculating the length of the intravascular component of the CVC based on height and insertion laterality were developed and compared to previously published formulas. These formulas were then trialed prospectively to validate reliability and application. RESULTS Formulas were developed for right-sided and left subclavian insertion. The right-side formula accurately predicted CVC length in 52.6% of patients, compared to 47.4% by the Andropoulos formula. The left subclavian formula accurately estimated 62.5%, compared to 34.5% by the Stroud formula. CONCLUSIONS The optimal intravascular length of central venous catheters may be determined by simple formulas based on patient height and insertion site. LEVEL OF EVIDENCE III.
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6
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Clopton R, Stone M, Ing RJ. In children with congenital heart disease should the left or right internal jugular vein be used for central venous access? J Cardiothorac Vasc Anesth 2022; 36:2488-2489. [DOI: 10.1053/j.jvca.2022.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 11/11/2022]
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Weber MD, Conlon T, Woods-Hill C, Watts SL, Nelson E, Traynor D, Zhang B, Davis D, Himebauch AS. Retrospective Assessment of Patient and Catheter Characteristics Associated With Malpositioned Central Venous Catheters in Pediatric Patients. Pediatr Crit Care Med 2022; 23:192-200. [PMID: 34999641 PMCID: PMC8897221 DOI: 10.1097/pcc.0000000000002882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The primary objective was to determine the prevalence and characteristics associated with malpositioned temporary, nontunneled central venous catheters (CVCs) placed via the internal jugular (IJ) and subclavian (SC) veins in pediatric patients. DESIGN Single-center retrospective cohort study. SETTING Quaternary academic PICU. PATIENTS Children greater than 1 month to less than 18 years who had a CVC placed between January 2014 and December 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was the CVC tip position located on the first postprocedural radiograph. CVC tip was defined as follows: "recommended" (tip location between the carina and two vertebral bodies inferior to the carina), "high" (tip location between one and four vertebral bodies superior to the carina), "low" (tip position three or more vertebral bodies inferior to the carina), and "other" (tip grossly malpositioned). Seven hundred eighty-one CVCs were included: 481 (61.6%) were in "recommended" position, 157 (20.1%) were "high," 131 (16.8%) were "low," and 12 (1.5%) were "other." Multiple multinomial regression (referenced to "recommended" position) showed that left-sided catheters (adjusted odds ratio [aOR], 2.00, 95% CI 1.17-3.40) were associated with "high" CVC tip positions, whereas weight greater than or equal to 40 kg had decreased odds of having a "high" CVC tip compared with the reference (aOR, 0.45; 95% CI, 0.24-0.83). Further, weight category 20-40 kg (aOR, 2.42; 95% CI, 1.38-4.23) and females (aOR, 1.51; 95% CI, 1.01-2.26) were associated with "low" CVC tip positions. There was no difference in rates of central line-associated blood stream infection, venous thromboembolism, or tissue plasminogen activator usage or dose between the CVCs with tips outside and those within the recommended location. CONCLUSIONS The prevalence of IJ and SC CVC tips outside of the recommended location was high. Left-sided catheters, patient weight, and sex were associated with malposition. Malpositioned catheters were not associated with increased harm.
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Affiliation(s)
- Mark D. Weber
- Children’s Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, School of Nursing at the University of Pennsylvania, Philadelphia Pennsylvania
| | - Thomas Conlon
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Charlotte Woods-Hill
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephanie L. Watts
- Children’s Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, School of Nursing at the University of Pennsylvania, Philadelphia Pennsylvania
| | - Eileen Nelson
- Children’s Hospital of Philadelphia, Department of Nursing, Philadelphia Pennsylvania
| | - Danielle Traynor
- Children’s Hospital of Philadelphia, Department of Nursing, Philadelphia Pennsylvania
| | - Bingqing Zhang
- Children’s Hospital of Philadelphia, Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit
| | - Daniela Davis
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Adam S. Himebauch
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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8
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Youn JK, Lee D, Ko D, Yeom I, Joo HJ, Kim HC, Kong HJ, Kim HY. Augmented Reality-Based Visual Cue for Guiding Central Catheter Insertion in Pediatric Oncologic Patients. World J Surg 2022; 46:942-948. [PMID: 35006323 DOI: 10.1007/s00268-021-06425-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pediatric hemato-oncologic patients require central catheters for chemotherapy, and the junction of the superior vena cava and right atrium is considered the ideal location for catheter tips. Skin landmarks or fluoroscopic supports have been applied to identify the cavoatrial junction; however, none has been recognized as the gold standard. Therefore, we aim to develop a safe and accurate technique using augmented reality technology for the location of the cavoatrial junction in pediatric hemato-oncologic patients. METHODS Fifteen oncology patients who underwent chest computed tomography were enrolled for Hickman catheter or chemoport insertion. With the aid of augmented reality technology, three-dimensional models of the internal jugular veins, external jugular veins, subclavian veins, superior vena cava, and right atrium were constructed. On inserting the central vein catheters, the cavoatrial junction identified using the three-dimensional models were marked on the body surface, the tip was positioned at the corresponding location, and the actual insertion location was confirmed using a portable x-ray machine. The proposed method was evaluated by comparing the distance from the cavoatrial junction to the augmented reality location with that to the conventional location on x-ray. RESULTS The mean distance between the cavoatrial junction and augmented reality location on x-ray was 1.2 cm, which was significantly shorter than that between the cavoatrial junction and conventional location (1.9 cm; P = 0.027). CONCLUSIONS Central catheter insertion using augmented reality technology is more safe and accurate than that using conventional methods and can be performed at no additional cost in oncology patients.
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Affiliation(s)
- Joong Kee Youn
- Department of Pediatric Surgery, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Pediatric Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea
| | - Dongheon Lee
- Department of Biomedical Engineering, Chungnam National University College of Medicine and Hospital, Daejeon, Republic of Korea
| | - Dayoung Ko
- Department of Pediatric Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Inhwa Yeom
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea
| | - Hyun-Jin Joo
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea
| | - Hee Chan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyoun-Joong Kong
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea.
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea.
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Liu S, Jiang L, Wang X. Intelligent Internet of Things Medical Technology in Implantable Intravenous Infusion Port in Children with Malignant Tumors. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:8936820. [PMID: 34876968 PMCID: PMC8645386 DOI: 10.1155/2021/8936820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022]
Abstract
Due to the recent technological revolution that is centered around information technology, the Internet of Medical Things (IoMT) has become an important research domain. IoMT is a combination of Internet of Things (IoT), big data, cloud computing, ubiquitous network, and three-dimensional holographic technology, which is used to build a smart medical diagnosis and treatment system. Additionally, this system should automate various activities, such as the patient's health record and health monitoring, which is an important issue in the development of modern and smart healthcare system. In this paper, we have thoroughly examined the role of a smart healthcare system architecture and other key supporting technologies in improving the health status of both indoor and outdoor patients. The proposed system has the capacity to investigate and predict (if feasible) the clinical application and nursing effects of totally implantable intravenous port (TIVAP) in pediatric hematological tumors. For this purpose, seventy children with hematologic tumors were treated with TIVAP, and IoMT-enabled care was provided to them, where the occurrence of adverse events, specifically after the treatment, was observed. The experimental results collected after the 70 children were treated and cared for by TIVAP show that there were five cases of adverse events, whereas the incidence rate of the adverse events was 7.14%. Moreover, TIVAP has significant efficacy in the treatment of hematologic tumors in children, and it equally reduces the vascular injury caused by chemotherapy in younger patients. Likewise, targeted care reduces the incidence of adverse events in children with expected ratio.
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Affiliation(s)
- Shaohong Liu
- Department of Pediatric Surgery, Hunan Children's Hospital, Changsha 410007, China
| | - Luxing Jiang
- Department of Pediatric Surgery, Hunan Children's Hospital, Changsha 410007, China
| | - Xin Wang
- Department of Pediatric Surgery, Hunan Children's Hospital, Changsha 410007, China
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10
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Glenski TA, Taylor CM, Doyle NM, Erkmann JJ, Huffman JC, Anyaso JC. Trimmed central venous catheters in pediatric cardiac surgery: Does height or weight correlate with the amount trimmed? Paediatr Anaesth 2021; 31:996-1002. [PMID: 34166555 DOI: 10.1111/pan.14246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/14/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Due to excess catheter length, pediatric patients undergoing cardiac surgery frequently have the tip of the central venous catheter trimmed while on bypass to obtain optimal catheter positioning. AIMS We sought to determine if there is a correlation between the patient's height or weight and the length of catheter removed. Our secondary aim compared the instances of central line-associated bloodstream infections and venous thromboembolisms between the trimmed and untrimmed catheters. METHODS This retrospective study included patients having undergone cardiac surgery over a 3-year period who had an 8 cm central venous catheter placed in the right internal jugular vein. Hospital lists of central line-associated bloodstream infections and venous thromboembolisms that occurred were cross referenced with our study patients. RESULTS There were 147 cases where the 8 cm central venous catheter was trimmed, which represents 35% of the cases. Of the catheters that were cut, on average 2.17 cm was removed. There is negligible correlation between the length of catheter removed and patient height (r = -.19, p = .021). There is negligible correlation between the length of catheter removed and patient weight (r = -.17, p = .039). There were no instances of central line-associated bloodstream infections or venous thromboembolisms attributed to the trimmed catheters. Of the 273 untrimmed catheters, there were no instances of an infection and one instance of a venous thromboembolism. CONCLUSION Right internal jugular 8 cm central venous catheters are trimmed during pediatric cardiac surgery, and there is minimal correlation between the length removed and the patient height or weight. Due to the difficulty in estimating the proper length of a central venous catheter in smaller pediatric patients, placing an 8 cm long catheter in these patients and then trimming the distal tip while on bypass may be the most accurate way to properly position a catheter.
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Affiliation(s)
- Todd A Glenski
- Department of Anesthesiology, Children's Mercy Hospital, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Christian M Taylor
- Department of Anesthesiology, Children's Mercy Hospital, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Nichole M Doyle
- Department of Anesthesiology, Children's Mercy Hospital, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri, USA
| | - John J Erkmann
- Department of Anesthesiology, Children's Mercy Hospital, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Joseph C Huffman
- Department of Anesthesiology, Children's Mercy Hospital, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Jessica C Anyaso
- Medical Student, School of Medicine, University of Missouri - Kansas City, Kansas City, Missouri, USA
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11
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Oh C, Hong B, Jo Y, Chung W, Kim H, Shin S, Choi AY, Lim C, Ko Y, Kim YH, Lee SY. A retrospective comparison for prediction of optimal length of right subclavian vein catheterization in infants: landmark-based estimation vs. linear regression model. Anesth Pain Med (Seoul) 2021; 16:258-265. [PMID: 34352966 PMCID: PMC8342824 DOI: 10.17085/apm.21021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/21/2021] [Indexed: 11/21/2022] Open
Abstract
Background The optimal insertion length for right subclavian vein catheterization in infants has not been determined. This study retrospectively compared landmark-based and linear regression model-based estimation of optimal insertion length for right subclavian vein catheterization in pediatric patients of corrected age < 1 year. Methods Fifty catheterizations of the right subclavian vein were analyzed. The landmark related distances were: from the needle insertion point (I) to the tip of the sternal head of the right clavicle (A) and from A to the midpoint (B) of the perpendicular line drawn from the sternal head of the right clavicle to the line connecting the nipples. The optimal length of insertion was retrospectively determined by reviewing post-procedural chest radiographs. Estimates using a landmark-based equation (IA + AB – intercept) and a linear regression model were compared with the optimal length of insertion. Results A landmark-based equation was determined as IA + AB – 5. The mean difference between the landmark-based estimate and the optimal insertion length was 1.0 mm (95% limits of agreement –18.2 to 20.3 mm). The mean difference between the linear regression model (26.681 – 4.014 × weight + 0.576 × IA + 0.537 × AB – 0.482 × postmenstrual age) and the optimal insertion length was 0 mm (95% limits of agreement –16.7 to 16.7 mm). The difference between the estimates using these two methods was not significant. Conclusions A simple landmark-based equation may be useful for estimating optimal insertion length in pediatric patients of corrected age < 1 year undergoing right subclavian vein catheterization.
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Affiliation(s)
- Chahyun Oh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Yumin Jo
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Woosuk Chung
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Hoseop Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Suyeon Shin
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Ah Young Choi
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
| | - Chaeseong Lim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Youngkwon Ko
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Yoon-Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Sun Yeul Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
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12
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Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are used routinely in neonatal care. Measures of surface anatomy have been used to estimate appropriate PICC depth in neonates since 1973. However, prior PICC research using anthropometric measures to estimate proper PICC insertion depth has been limited to pediatric and adult literature. PURPOSE The purpose of this study was to explore the relationships among a neonate's anthropometric measures and the appropriate PICC insertion depth. METHODS Neonates requiring PICC insertion at Nationwide Children's Hospital were enrolled between January and September 2018. Standard PICC procedures were followed. The research group corroborated appropriate PICC tip position of enrolled infants. Multivariable linear regression with robust standard errors was used to evaluate linear relationships between PICC insertion depth and current weight, current length, and PICC insertion site. RESULTS Demographics of enrolled infants included gestational ages of 23 to 39 weeks, weights of 510 to 3870 g, and lengths of 31 to 54 cm. Of the 56 infants considered, final statistical analysis included 49 neonates (14 ankle, 16 knee, and 19 antecubital insertions). Current neonatal weight was associated with PICC depth at all sites (all Ps < .0001). Current neonatal length was associated with PICC depth at all sites (all Ps < .0001). Preprocedure surface measurement was also strongly associated with PICC insertion depth (P < .0001). IMPLICATIONS FOR PRACTICE This investigation demonstrated a relationship for both neonatal weight and length that may be an anthropometric model for neonatal PICC insertion depth. IMPLICATIONS FOR RESEARCH A more robust sample size could more precisely define the anthropometric model.
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13
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Ye P, Tan Y, Shi S, Liu L. Optimal insertion depth of subclavian vein catheterization via the right supraclavicular approach in children. Paediatr Anaesth 2021; 31:346-351. [PMID: 33336473 DOI: 10.1111/pan.14107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Methods to determine the optimal insertion depth of ultrasound-guided supraclavicular approach to the subclavian vein (SCV) catheterization, alternatively used for central venous access, are debatable in children. AIM We investigated the applicability and reliability of the modified formula for determining the depth of SCV catheterization using an ultrasound-guided supraclavicular approach in children. METHODS This prospective observational study included 36 children (age <6 years; weight ≥5 kg) scheduled to undergo congenital heart disease surgery. After intubation, ultrasound-guided supraclavicular approach to the SCV catheterization was performed. Actual insertion depth was determined by real-time transesophageal echocardiography. Insertion depth was calculated by subtracting 1 cm from the sum of the distance from the insertion point to the sternal head of the right clavicle and that from the latter point to the midpoint of a perpendicular line drawn from the sternal head of the right clavicle to the line connecting the nipples. RESULTS Insertion depth calculated with the modified formula and actual insertion depth of the SCV catheter correlated strongly (r = .806, 95% confidence interval [CI]: 0.658-0.908; p < .001). Bland-Altman analysis showed a mean bias and precision of 0.36 and 0.65 cm, respectively (95% CI: 0.14-0.58, 95% limits of agreement: -0.92, 1.64). All plots were above the -1.0 line, indicating no catheter tip insertion into the right atrium. CONCLUSIONS Optimal insertion depth for an ultrasound-guided supraclavicular approach to the SCV catheterization can be calculated using modification of a surface landmark formula in children younger than 6 years and weight heavier than 5 kg.
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Affiliation(s)
- Ping Ye
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yanzhe Tan
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Shujun Shi
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Lifei Liu
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
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14
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Yang S, Kong X, Liu L, Xu Y, Zhang J. Application of transesophageal echocardiography for localization in totally implantable venous access port implantation through subclavian approach in children. Clin Cardiol 2020; 44:129-135. [PMID: 33241579 PMCID: PMC7803355 DOI: 10.1002/clc.23518] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 11/18/2022] Open
Abstract
A totally implantable venous access port (TIVAP) is important in children who need intravenous infusion for a long time. A number of studies have shown methods for locating the tip of the TIVAP catheter. To explore whether transesophageal echocardiography (TEE) can be used to accurately locate the TIVAP catheter tip through a subclavian approach and to improve the rate of correct TIVAP catheter placement and reduce complications of TIVAP placement. In 36 children who needed TIVAP implantation surgery, we used real‐time TEE guidance to place the catheter tip around the crista terminalis. In all children, chest X‐rays were used to figure out whether the catheter tip as localized by TEE was within the T5‐T7 segment. Then, we compared the length of the catheter calculated by the height formula and the actual catheter length applied under TEE guidance. The medical records, surgical details, nursing records, and recorded complications were collected during the follow‐up. The success rate of TIVAP implantation was 100% in all enrolled patients and no hemopneumothorax or pinch‐off syndrome occurred. Compared with TEE, chest X‐ray showed a coincidence rate of 80.56% in correctly detecting the TIVAP catheter tip locate. The height‐derived catheter length (11.0 [9.6, 11.8]) cm and the TEE‐derived catheter length (10.0 [9.3, 10.8]) cm were significantly different (p < .001). TEE can be used to guide TIVAP catheter positioning through a left subclavian approach in children accurately and successfully and more accurate than chest X‐ray and height calculation formula.
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Affiliation(s)
- Shujun Yang
- Department of Anesthesiology, Chongqing Medical University Affiliated Children's Hospital, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child development and Critical Disorders, Chongqing, China.,Childrens Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiangru Kong
- Department of Surgical Oncology, Chongqing Medical University Affiliated Children's Hospital, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child development and Critical Disorders, Chongqing, China.,Childrens Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lifei Liu
- Department of Anesthesiology, Chongqing Medical University Affiliated Children's Hospital, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child development and Critical Disorders, Chongqing, China.,Childrens Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ying Xu
- Department of Anesthesiology, Chongqing Medical University Affiliated Children's Hospital, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child development and Critical Disorders, Chongqing, China.,Childrens Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jun Zhang
- Department of Surgical Oncology, Chongqing Medical University Affiliated Children's Hospital, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child development and Critical Disorders, Chongqing, China.,Childrens Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
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15
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Stone M, Choi R, Ing RJ. Optimization of Right Internal Jugular Central Venous Catheter Length in Pediatric Cardiac Surgical Patients. J Cardiothorac Vasc Anesth 2020; 34:2392-2394. [DOI: 10.1053/j.jvca.2020.04.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/16/2020] [Indexed: 11/11/2022]
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16
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Maddali MM, Al-Shamsi F, Arora NR, Panchatcharam SM. The Optimal Length of Insertion for Central Venous Catheters Via the Right Internal Jugular Vein in Pediatric Cardiac Surgical Patients. J Cardiothorac Vasc Anesth 2020; 34:2386-2391. [DOI: 10.1053/j.jvca.2020.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/27/2020] [Accepted: 03/04/2020] [Indexed: 11/11/2022]
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17
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Samerchua A, Kongwatmai K, Boonsri S, Pipanmekaporn T, Bunchungmongkol N, Sukhupragarn W, Visrutaratina P. A Comparison of the external anatomical landmark and the radiological landmark for obtaining the optimal depth of a right internal jugular venous catheter in pediatric cardiac patients. Paediatr Anaesth 2020; 30:490-497. [PMID: 32011044 DOI: 10.1111/pan.13836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 01/15/2020] [Accepted: 01/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The external anatomical landmark and the radiological landmark have been introduced to provide estimation of the depth of right internal jugular venous catheter during insertion. AIMS This study aimed to compare the accuracy, agreement, and reliability of the external anatomical landmark and the radiological landmark, confirmation being by transesophageal echocardiography. METHODS This prospective observational study was conducted in children ages 1-15 years. The catheter was placed at the superior vena cava and the right atrium junction guided by transesophageal echocardiography. The catheter depth derived from the transesophageal echocardiography, the external anatomical landmark, and the radiological landmark was recorded. The optimal zone of the catheter tip was 5 mm below and 10 mm above the superior vena cava and the right atrium junction. Accuracy was assessed by the difference between the transesophageal echocardiography and the external anatomical landmark or the radiological landmark. Agreement with Bland-Altman plots and correlation were tested. RESULTS Eighty participants, median age of 3 years, were enrolled. The median (IQR) differences between the depth of the transesophageal echocardiography and the external anatomical landmark or the radiological landmark were 0.30 (0, 0.70) and 0.10 (-0.20, 0.90) cm, respectively. Bland-Altman plots demonstrated good agreement between the depths. The catheter tips were located in the optimal zone more frequently with the external anatomical landmark than the radiological landmark (94.7% vs 64.5%). The external anatomical landmark showed a stronger correlation to transesophageal echocardiography than the radiological landmark (r = .95 vs .83). CONCLUSION Both the external anatomical landmark and the radiological landmark enabled accurate estimation of the central venous catheter depth close to the superior vena cava and the right atrium junction. The external anatomical landmark is of more potential use than the radiological landmark in clinical practice.
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Affiliation(s)
- Artid Samerchua
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kritanon Kongwatmai
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Settapong Boonsri
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tanyong Pipanmekaporn
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Wariya Sukhupragarn
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pannee Visrutaratina
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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18
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Xu H, Zhu X, Li J, Yao Y, Guo M, Yu T, Xiong X, Huang Z, Miao L, Lin D. Using sternal angle as anatomic landmark for right internal jugular vein catheterization in pediatrics. Acta Anaesthesiol Scand 2020; 64:188-192. [PMID: 31529467 DOI: 10.1111/aas.13474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/19/2019] [Accepted: 09/03/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many formulas based on the patient's height, weight and/or age exist to determine central venous catheter (CVC) depth in children. However, this information is unavailable in some emergency conditions. Therefore, direct methods should be developed to guide catheter position in children. METHODS Eighty patients aged 1-10 y were enrolled from July 2015 to August 2016 and seventy-five were completed; fifty were male, and twenty-five were female. The exclusion criteria were inability to identify the sternal angle or failure to use the right internal jugular vein approach. The catheter was inserted using the right internal jugular vein approach, the distance from the skin puncture point to the midpoint of the sternal angle plane was measured, and the catheter tip was positioned to this distance minus 1 cm. Chest radiography were performed for those children after catheter insertion. The relative position between the catheter tip and carina was confirmed and the longitudinal distance from the catheter tip to the carina was calculated on radiographic images, and related complications were recorded. RESULTS All catheter tips were above the carina, and the average distance from the catheter tip to the carina was 9.8 mm. No patients experienced serious complications. CONCLUSION The sternal angle is a useful and reliable anatomic landmark for guiding CVC position in children. Using this landmark, the catheter can be quickly and conveniently placed at a safety position in right internal jugular vein, especially in some emergency conditions.
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Affiliation(s)
- Hui Xu
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Xiaoqiu Zhu
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Jin Li
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Yiyi Yao
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Mingyan Guo
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Taihui Yu
- Department of Radiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Xilin Xiong
- Department of Pediatrics Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Zhiquan Huang
- Department of Oral and Maxillofacial Surgery Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Liping Miao
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - Daowei Lin
- Department of Anesthesiology Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
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19
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Qin KR, Nataraja RM, Pacilli M. Letter to the Editor. J Pediatr Surg 2019; 54:866. [PMID: 30651191 DOI: 10.1016/j.jpedsurg.2018.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Kirby R Qin
- Department of Paediatric Surgery, Monash Children's Hospital, Monash University, Melbourne, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, Monash University, Melbourne, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Monash Children's Hospital, Monash University, Melbourne, Australia.
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21
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Chaskar V, Karnik PP, Dave NM, Garasia M. Comparative Study of Three Methods for Depth of Central Venous Catheter Placement in Children: An Observational Pilot Study. Turk J Anaesthesiol Reanim 2018; 46:116-120. [PMID: 29744246 DOI: 10.5152/tjar.2018.32748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 02/06/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Central venous cannulation of the internal jugular vein is difficult in paediatric patients because of the small size of the vein and anatomic variations. Many studies have shown the accuracy of various formulae for calculating the depth of placement. The aim of this study was to assess the most reliable method for central venous catheter (CVC) tip placement in paediatric patients. Methods Sixty-nine patients in the age groups from 0 to 12 years were divided in three groups for three published techniques for catheter tip placement. In Group E, catheter tip was placed at the distance measured from entry point to sternal angle. In Groups P and H, Peres and trans-oesophageal echocardiography (TEE)-derived formulae, respectively, were used for catheter placement. Post-procedure chest radiograph was performed for all patients, and tip position was recorded. Appropriate catheter tip position was considered just above or at the level of carina. The number of attempts and complications were recorded. Chi-square test was used for statistical analysis. Results Of 69 patients, 65% of patients in Group P, 52% in group H and 91% in group E had appropriate CVC tip placement. The chi-square test showed that the difference in the number of patients with appropriately positioned CVC tip among the three groups was statistically significant (p=0.0134), with intergroup analysis showing Group E to be superior. One patient had an episode of arrhythmia during guide wire insertion and was resuscitated successfully. Conclusion Catheter tip placement by external distance or landmark technique is a more accurate method for catheter placement than the Peres and TEE-based formulae. It does not require measurement of patients' height and reduces the chances of repositioning of catheter.
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Affiliation(s)
- Vaishali Chaskar
- Department of Anaesthesiology, Seth G.S. Medical College, K.E.M. Hospital, Mumbai, India
| | | | - Nandini Malay Dave
- Department of Anaesthesiology, Seth G.S. Medical College, K.E.M. Hospital, Mumbai, India
| | - Madhu Garasia
- Department of Anaesthesiology, Seth G.S. Medical College, K.E.M. Hospital, Mumbai, India
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22
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Lee JH, Byon HJ, Choi YH, Song IK, Kim JT, Kim HS. Determination of the optimal depth of a left internal jugular venous catheter in infants: A prospective observational study. Paediatr Anaesth 2017; 27:1220-1226. [PMID: 29044814 DOI: 10.1111/pan.13258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few reports exist regarding the optimal depth of a left-sided central venous catheter in pediatric patients. We aimed to provide a guideline for the optimal depth of central venous catheters at the left internal jugular vein in infants, using anatomical landmarks, age, height, and weight. METHODS A two-stage study was conducted. In the first observational study, infants aged ≤1 year and scheduled for elective surgery requiring a central venous catheter were enrolled. The tip of the central venous catheter was confirmed using transthoracic echocardiography. Linear regression modeling was performed to determine the association between the insertion depth of the central venous catheter and the I-A-B distance (I, the insertion point; A, the sternal head of the left clavicle; B, the midpoint of the perpendicular line drawn between the sternal head of the right clavicle and an imaginary line between the nipples), based on age, height, and weight. In the second study, the results of the first study were validated in another group of consecutive infants. RESULTS In the first study, the data of 67 patients were analyzed. The infant's height and I-A-B distance were highly correlated with the level of the central venous catheter tip (R2 =0.763 and 0.772, respectively; all P < .01), using the regression equations 0.11 × height (cm) + 0.19 and 1.02 × I-A-B (cm) + 1.55, respectively. In the second study, height was also highly correlated with the insertion depth of the central venous catheter in another 42 infants (r = .938, P = <.001). In a Bland-Altman's analysis, the mean bias and precision of the actual insertion depth and predicted depth using height were 0.09 and 0.15 cm, respectively. The limits of agreement were -0.19 and 0.38 cm, respectively. CONCLUSION In infants, the optimal depth of a central venous catheter at the left internal jugular vein can be determined with a simple formula using height.
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Affiliation(s)
- Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyo-Jin Byon
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon-Hyeong Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - In-Kyung Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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23
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[Avoidance of complications when dealing with central venous catheters in the treatment of children]. Anaesthesist 2017; 66:265-273. [PMID: 28175940 DOI: 10.1007/s00101-017-0275-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Central venous catheters (CVCs) are an important tool in the treatment of children. The insertion of a catheter may result in different complications depending of the type of catheter, the technique used for the insertion and the location. There are various techniques to reduce the risk of complications. In order to reduce the rate of complications of CVCs it is indispensable to perform a risk-benefit analysis for the individual patient before every insertion. The type of catheter used (for example tunneled catheters versus not-tunneled catheters) influences the rate of catheter-associated infections and the comfort of the patient significantly. The choice of the location is influenced by the expected indwelling time, the weight of the patient and the purpose of the CVC. Insertion via the vena jugularis interna is often chosen because of the reduced rate of complications during insertion. When the planned indwelling time of the catheter is longer or the child is fairly small the vena subclavia appears to be more appropriate. It is of utmost importance that the patient is positioned properly before insertion. Whenever possible the insertion should be performed with the help of ultrasound. The positioning of the catheter should be verified radiographically, possibly sonographically or with an ECG in order to avoid misplacement with potentially severe sequelae. The locally established hygienic guidelines should be strictly adhered to and everyone handling CVCs (doctors, nurses and patients) should have regular training.
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Barnwal NK, Dave ST, Dias R. A comparative study of two techniques (electrocardiogram- and landmark-guided) for correct depth of the central venous catheter placement in paediatric patients undergoing elective cardiovascular surgery. Indian J Anaesth 2016; 60:470-5. [PMID: 27512162 PMCID: PMC4966350 DOI: 10.4103/0019-5049.186030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background and Aims: The complications of central venous catheterisation can be minimized by ensuring catheter tip placement just above the superior vena cava-right atrium junction. We aimed to compare two methods, using an electrocardiogram (ECG) or landmark as guides, for assessing correct depth of central venous catheter (CVC) placement. Methods: In a prospective randomised study of sixty patients of <12 years of age, thirty patients each were allotted randomly to two groups (ECG and landmark). After induction, central venous catheterisation was performed by either of the two techniques and position of CVC tip was compared in post-operative chest X-ray with respect to carina. Unpaired t-test was used for quantitative data and Chi-square test was used for qualitative data. Results: In ECG group, positions of CVC tip were above carina in 12, at carina in 9 and below carina in 9 patients. In landmark group, the positions of CVC tips were above carina in 10, at carina in 4 and below carina in 16 patients. Mean distance of CVC tip in ECG group was 0.34 ± 0.23 cm and 0.66 ± 0.35 cm in landmark group (P = 0.0001). Complications occurred in one patient in ECG group and in nine patients in landmark group (P = 0.0056). Conclusion: Overall, landmark-guided technique was comparable with ECG technique. ECG-guided technique was more precise for CVC tip placement closer to carina. The incidence of complications was more in the landmark group.
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Affiliation(s)
- Neeraj Kumar Barnwal
- Department of Anaesthesiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sona T Dave
- Department of Anaesthesiology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Raylene Dias
- Department of Anaesthesiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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25
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Tarr GP, Pak N, Taghavi K, Iwan T, Dumble C, Davies-Payne D, Mirjalili SA. Defining the surface anatomy of the central venous system in children. Clin Anat 2015; 29:157-64. [PMID: 26518452 DOI: 10.1002/ca.22663] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 10/20/2015] [Accepted: 10/28/2015] [Indexed: 11/06/2022]
Abstract
Pediatric emergency physicians, pediatric critical care specialists, and pediatric surgeons perform central venous catheterization in many clinical settings. Complications of the procedure are not uncommon and can be fatal. Despite the frequency of application, the evidence-base describing the surface landmarks involved is missing. The aim of the current study was to critically investigate the surface markings of the central venous system in children. The superior vena cava/right atrial (SVC/RA) junction, superior vena cava (SVC) formation, and brachiocephalic vein (BCV) formation were examined independently by two investigators. Three hundred computed tomography (CT) scans collected across multiple centers were categorized by age group into: 0-3 years, 4-7 years, and 8-11 years. Scans with pathology that distorted or obscured the regional anatomy were excluded. The BCV formation was commonly found behind the ipsilateral medial clavicular head throughout childhood. This contrasts with the variable levels of SVC formation, SVC length, and SVC/RA junction. In the youngest group, SVC formation was most commonly at the second costal cartilage (CC), but moved to the first CC/first intercostal space (ICS) as the child grew. The SVC/RA junction was at the fourth CC in the youngest group and moved to the third CC/third ICS as the child grew. This study demonstrates the variable anatomy of SVC formation and the SVC/RA junction with respect to rib level. This variability underscores the unreliability of surface anatomical landmarks of the SVC/RA junction as a guide to catheter tip position.
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Affiliation(s)
- Gregory P Tarr
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand
| | - Neda Pak
- Department of Radiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kiarash Taghavi
- Department of Paediatric Surgery, Wellington Hospital, Wellington, New Zealand
| | - Tom Iwan
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charlotte Dumble
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - S Ali Mirjalili
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Park YH, Lee JH, Byon HJ, Kim HS, Kim JT. Transthoracic echocardiographic guidance for obtaining an optimal insertion length of internal jugular venous catheters in infants. Paediatr Anaesth 2014; 24:927-32. [PMID: 24853395 DOI: 10.1111/pan.12443] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are multiple methods of determining the optimal position of central venous catheter (CVC) tips. The purpose of this study was to assess the feasibility of transthoracic echocardiography (TTE), and compare TTE and height-based method for correct positioning of CVCs in infants undergoing cardiac surgery. METHODS Ultrasonography-guided central venous catheterization was performed via the right internal jugular vein. Longitudinal images of the right atrium and superior vena cava were obtained using TTE. The catheter tip was located 10 mm above the crista terminalis. If the catheter tip was not clearly visualized, the probe was rotated to obtain transverse images and the CVC tip was positioned at the level of the pulmonary artery bifurcation. The mean distance from the catheter tip to the level of the carina was compared with that calculated using a height-based formula. RESULTS Among 106 cases, positioning of the CVC tip under TTE guidance failed in four patients; thus, the success rate was 96.2%. The mean distance from the CVC tip to the level of the carina was different for positioning using the TTE method (-3.8 ± 8.2 mm; 95% confidence interval, -5.5 to -2.2 mm) and that using the height-based formula (6.1 ± 9.6 mm; 95% CI, 4.2 to 8.0 mm; P = 0.001). The distance was consistent regardless of the height when the insertion length was determined using TTE (r = -0.048, P > 0.05). CONCLUSIONS Transthoracic echocardiography is a practical method for the correct placement of the CVC tip with less variability compared to the height-based method.
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Affiliation(s)
- Yong-Hee Park
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, Korea
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Simple formulas to determine optimal subclavian central venous catheter tip placement in infants and children. J Pediatr Surg 2014; 49:1109-12. [PMID: 24952798 DOI: 10.1016/j.jpedsurg.2013.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 11/20/2013] [Accepted: 12/31/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND/PURPOSE Optimal central venous catheter (CVC) tip location is necessary to decrease the incidence of complications related to their use. We sought to create a practical method to reliably predict the length of catheter to insert into the subclavian vein during CVC placement in children. METHODS We performed a retrospective review of 727 chest radiographs of children who underwent either left or right subclavian CVC placement. We measured the distance from the subclavian entry site to the to the right atrium/superior vena cava (RA/SVC) junction, following the catheter's course. We analyzed the relationship between that length and patient characteristics, including: age, gender, height, weight and body surface area (BSA). RESULTS Two derived formulas using the BSA best correlated with the optimal subclavian CVC length. For the left subclavian vein approach, the optimal catheter length was 6.5 BSA+7 cm, and for the right subclavian vein approach it was 5 BSA+6. The use of these formulas correlated in CVC tip placement in a clinically proper location in 92.9% of smaller children and in 95.7% of larger children. CONCLUSION The optimal length of central venous catheter to insert into the subclavian vein may be determined through the use of a simple formula using the BSA.
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Defining Central venous Line Position in Children: Tips for the Tip. J Vasc Access 2014; 16:77-86. [DOI: 10.5301/jva.5000285] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2014] [Indexed: 11/20/2022] Open
Abstract
Purpose The purpose of this study is to analyse literature related to the position of centrally inserted central venous catheters and to review topics related to assessment of tip position of those catheters in children. Applications of specific techniques to PICCs (Periferally Inserted Central Catheters) and umbilical venous catheter will also be reviewed. Methods Analysis of 68 original manuscripts, 42 specifically related to the paediatric population, 26 related to the adult population. The papers analysed were published between 1949 and 2014; all articles were in English except one in Italian and one in German. Results From the analysed literature, most of the guidelines recommend tip positioning at a level between the superior vena cava and the right atrium. Several methods have been described to evaluate tip position in the paediatric population, but none of those is considered completely reliable. The standard methods used to identify catheter tip position are radiography and fluoroscopy, but no specific landmark can be recommended in the paediatric population. The ultrasonographic approach has been investigated mainly for PICCs positioning in the neonatal population. The electrocardiographic method has been evaluated in the general paediatric population. Conclusions No specific recommendation can be given due to the low level of evidence. Ultrasound and ECG (electrocardiogram) techniques are a potential alternative to chest X-ray and further studies should be implemented to establish them. A wider application of these techniques may reduce neonatal and paediatric exposure to radiations and additionally reduce costs.
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Kim H, Jeong CH, Byon HJ, Shin HK, Yun TJ, Lee JH, Park YH, Kim JT. Predicting the optimal depth of left-sided central venous catheters in children. Anaesthesia 2013; 68:1033-7. [DOI: 10.1111/anae.12371] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2013] [Indexed: 11/30/2022]
Affiliation(s)
- H. Kim
- Department of Anesthesiology and Pain Medicine; Severance Hospital; Yonsei University College of Medicine; Seoul; Korea
| | - C-H. Jeong
- Department of Anesthesiology and Pain Medicine; Inha University Hospital; Incheon; Korea
| | - H-J. Byon
- Department of Anesthesiology and Pain Medicine; Inha University Hospital; Incheon; Korea
| | - H. K. Shin
- Department of Anesthesiology and Pain Medicine; Inha University Hospital; Incheon; Korea
| | - T. J. Yun
- Department of Radiology; Seoul National University Hospital; Seoul; Korea
| | - J-H. Lee
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul; Korea
| | - Y-H. Park
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul; Korea
| | - J-T. Kim
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul; Korea
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Na HS, Kim JT, Kim HS, Bahk JH, Kim CS, Kim SD. Practical anatomic landmarks for determining the insertion depth of central venous catheter in paediatric patients. Br J Anaesth 2009; 102:820-3. [PMID: 19380312 DOI: 10.1093/bja/aep078] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Various methods have been recommended to decide a proper insertion depth of central venous catheter (CVC). The carina is recommended as a useful target level for the CVC tip position. We evaluated the sternal head of a right clavicle and the nipples as anatomic landmarks for determining the optimal depth of CVC in paediatric patients. METHODS Ninety children, <5 yr, undergoing catheterization through the right internal jugular vein were enrolled. The insertion depth was determined as follows. The insertion point was designated as 'Point I'. The sternal head of the right clavicle was called 'Point A' and the midpoint of the perpendicular line drawn from Point A to the line connecting both nipples was called 'Point B'. The insertion depth of CVC was determined by adding the two distances (from I to A and from A to B) and subtracting 0.5 cm from this. A chest radiography was taken and the distance of the CVC tip from the carina level was measured by the Picture Archiving and Communicating System. RESULTS The mean distance of the CVC tip from the carina level was 0.1 (1.0) (P=0.293) cm above the carina (95% CI 0.1 cm below the carina-0.3 cm above the carina). There was no specific relationship between the distance of the CVC tip from the carina level and the patients' age, height, and weight. CONCLUSIONS The CVC tip could be placed near the carina by using the external landmarks without any formulae, images, and devices in children in our study.
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Affiliation(s)
- H S Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
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Tercier S, Gapany C, Diezi M, Clément C, Lemay K, Joseph JM. Incidents and complications of totally implanted vascular access devices in children: a prospective study. Patient Saf Surg 2008; 2:30. [PMID: 19014527 PMCID: PMC2588558 DOI: 10.1186/1754-9493-2-30] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 11/13/2008] [Indexed: 11/29/2022] Open
Abstract
Background Totally implanted vascular access devices are frequently used in children for repeated blood samples or intravenous treatments. This prospective study aims at identifying the risk factors associated with infections, obstructions and surgical complications of these devices in pediatric patients. Methods From January 2006 to January 2008, all children older than one year of age with a diagnosis of solid or blood cell malignancy were included in the study. Insertion was performed by the surgeon according to a standardized protocol after landmark-guided puncture of the subclavian or internal jugular vein by a senior anesthesiologist. Dressing and post-operative care were standardized. Every manipulation was prospectively recorded by specialized dedicated nurses, and all patients were screened for complications one month post-surgery. Results 45 consecutive patients 1 to 16 years old were enrolled in the study. Mean age at the time of procedure was 8.5 years (range 1.3–15.6; SD ± 4.88). There were 12 peroperative adverse events in 45 procedures (27%), detailed as follows: 3 pneumothoraces (7%), 3 hematomas (7%), 6 arterial punctures (13%). Among these events, intervention was necessary for two pneumothorax and one arterial puncture. There was no air embolism. At one month, we recorded 5 post-operative complications (11%): 2 thrombotic obstructions, one unsightly scar, and one scapular pain of unknown etiology. One patient needed repositioning of the catheter. There was no catheter-related infection. Conclusion Prospective recording of TIVA insertion in children reveals a significant number of early incidents and complications, mainly associated with the percutaneous puncture technique. We found no infection in this series. Results of a longer follow-up in the same population are pending.
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Affiliation(s)
- Stéphane Tercier
- Pediatric Surgery, Centre hospitalier universitaire vaudois and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Christophe Gapany
- Pediatric Surgery, Centre hospitalier universitaire vaudois and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Manuel Diezi
- Pediatric oncology and hematology unit, Centre hospitalier universitaire vaudois and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Chantal Clément
- Pediatric oncology and hematology unit, Centre hospitalier universitaire vaudois and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Katy Lemay
- Pediatric oncology and hematology unit, Centre hospitalier universitaire vaudois and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Jean-Marc Joseph
- Pediatric Surgery, Centre hospitalier universitaire vaudois and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
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Maddali MM, Mohamed B. In the vein but in vain. Paediatr Anaesth 2008; 18:684-6. [PMID: 18616497 DOI: 10.1111/j.1460-9592.2008.02523.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hsu JH, Wang CK, Hung CW, Wang SS, Cheng KI, Wu JR. Transesophageal Echocardiography and Laryngeal Mask Airway for Placement of Permanent Central Venous Catheter in Cancer Patients with Radiographically Unidentifiable SVC-RA Junction: Effectiveness and Safety. Kaohsiung J Med Sci 2007; 23:435-41. [PMID: 17766211 DOI: 10.1016/s1607-551x(08)70050-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
In patients who require a permanent central venous catheter (PCVC), the usual aim is to put the catheter tip at the superior vena cava and right atrium (SVC-RA) junction. However, there is no study regarding how to guide the positioning of the catheter tip when the SVC-RA junction cannot be identified on chest radiograph. The objectives of this prospective study were: (1) to investigate the incidence and etiologies of radiographically undetermined SVC-RA junctions in cancer patients undergoing PCVC implantation; and (2) to evaluate the feasibility, effectiveness and safety of combined transesophageal echocardiography (TEE) and laryngeal mask airway (LMA) to guide the positioning of catheters during implantations in patients without this radiographic landmark. Over a 1-year study period, 83 consecutive patients with oncologic diseases who required implantation of a PCVC in a tertiary center were screened. Their preoperative chest radiographs were examined by radiologists to identify the presence of the SVC-RA junction. Patients without a radiographically identifiable SVC-RA junction were classified as cancer-related or cancer-unrelated in terms of etiology. For patients without this landmark, we used TEE with a pediatric biplane transducer and a LMA under intravenous general anesthesia during PCVC implantation to guide the positioning of the catheter tip at the SVC-RA junction. We found that in 16% (13/83) of patients, the SVC-RA junction could not be identified on radiograph. Among the 13 patients, only three (23%) had cancer-related etiologies. In all of the 13 patients, the LMA was successfully placed after the TEE transducer was inserted. No episode of air leak from the LMA was found during surgery. All had the catheter tip positioned in the anatomic SVC-RA junction under TEE guidance. In conclusion, 16% of cancer patients requiring PCVC implantation had no identifiable SVC-RA junction on chest radiograph and most causes were cancer-unrelated. In patients without a radiographically identifiable SVC-RA junction, guidance by TEE under LMA general anesthesia is a feasible, safe and effective management to position a PCVC at the SVC-RA junction.
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Affiliation(s)
- Jong-Hau Hsu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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