| Subclavian Catheterization in the Pediatric Patients |
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Seung Hee Lee, Sung Ho Cho, Keun Mo Kim, Chan Jong Kim, Hoon Kook, Tai Ju Hwang |
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Department of Pediatrics, Chonnam National University Medical School, Kwangju, Korea |
| 소아 영역에서 Subclavian Catheterization의 경험 |
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최승희, 조성호, 김근모, 김찬종, 국훈, 황태주 |
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전남대학교 의과대학 소아과학교실 |
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| Abstract |
Purpose
: Central venous catheters are used to deliver antibiotics, chemotherapeutic
agents, and parenteral nutrition for a extended period of time as well as to draw
samples in immunocompromised patients to minimize the discomfort with sampling and
the risk of introducing infections. Hickman/Broviac catheters or implantable devices
have been used in pediatric patients. This study is aimed to evaluate the safety and
clinical efficacy of subclavian catheterization which has advantages of low cost without need of general anesthesia or skillful surgeon.
Methods
: Between August 1994 and October 1995, subclavian venous catheters were
inserted in 22 patients. The age ranged from 3 months to 17 years (median 9 years 5
months). Patients weight ranged from 5.7kg to 57.0kg (median 27.5kg). Nineteen
patients had various malignancies. ArrowⓇ multi-lumen/ two-lumen central venous
catheters were used. Without general anesthesia, pediatricians inserted the subclavian catheters by blind puncture at bedside after administering 0.035mg/kg of midazolam and 0.05mg/kg of morphine sulfate. EmlaⓇ cream was applied at the puncture site one hour prior to the procedure. We retrospectively evaluated the patient characteristics and complications associated with catheter placement and maintenance.
Results
: The median duration of catheter placement was 53 days, with a range of 6
to 175 days.In early series, 2 cases of pneumothorax and a case of hemothorax
occured during the catheter insertion. Occlusion and infection of catheters occured in 11 and 6 patients, respectively. Twenty catheters were removed: no need to continue,7; patient death, 4; inadvertent removal, 4; complete occlusion 3 and 2 cases of catheter-relatedinfections.
Conclusion
: Subclavian catheterization is a safe, cost-effective, easy-to-perform
technique of providing long-term venous access which can be done by pediatrician at
bedside without the risk of general anesthesia. |
| Key Words:
Subclavian catheterization, Pediatric patients, Emla |
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