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Vascular Access/IV
Clinical Skills

Risk factors for a failed first attempt at pediatric subclavian central venous catheters and the role of single-attempt placement in reducing catheter-related morbidity: a prospective observational study

21 November 2024
Canadian Vascular Access Association

Abstract

Introduction:

The aim of this observational study was to investigate the risk factors of a failed first attempt at pediatric central venous catheter (CVC) placement and its impact on CVC-related morbidity.

Materials and Methods:

In this prospective observational study, we included 3-month-to 5-year-old children proposed for infraclavicular subclavian vein catheterization consecutively sing the anatomic landmark technique. Patients were divided into two groups: group 1 included single-attempt catheter placements, and Group 2 included failed first attempts at catheter placement. The management protocol was standardized for all patients. After comparing the two groups, univariable logistic regression was used to investigate the risk factors for a failed first attempt and to show the interest of the single-attempt catheter placement.

Results:

Among 150 pediatric CVC placements, the incidence of failed first attempts was 41.3% and its main risk factors were children with comorbidities (OR=3.11; 95%CI: 1.17–8.21), hematology and oncology patients (OR=5.6; 95%CI: 2.75–11.38), children with aplastic anemia (OR=3.05; 95%CI:1.388–6.705), and anesthesia sedation with I-Gel airway ventilation (OR=9.21; 95%CI: 1.080–78.5). On the other hand, a single-attempt catheter placement was a protective factor against catheter-related complications with OR=0.258 [0.12–0.55].

Conclusion:

It seems that a single-attempt CVC placement may reduce the incidence of complications. The knowledge of the main risk factors of failed first attempts is mandatory for taking necessary precautions.

The pediatric population is known to have more difficult venous access than adults and they often require central venous access for several reasons (Kammoun et al, 2022). In low- and middle-income countries (LMICs), the management of pediatric venous access can have multiple insufficiencies, such as the unavailability of ultrasound and the lack of experienced physicians and skilled nurses, which can make central venous catheter (CVC) placement more difficult and require several attempts (Jarraya et al, 2023).

In our setting, infraclavicular subclavian CVC is commonly used among infants and young children using the landmark technique and a high rate of complications, particularly central line-associated blood stream infections (CLABSIs), was previously reported despite the implementation of a quality management system (Zouari et al, 2018; Jarraya et al, 2023; Kammoun et al, 2023).

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Pediatric
Central venous access
Failed first attempt
Risk factors
Complications