All issues > Volume 40(3); 1997

Original Article

J Korean Pediatr Soc. 1997;40(3):368-374. Published online March 15, 1997.

Subclavian Catheterization in the Pediatric Patients

Seung Hee SH Lee¹, Sung Ho SH Cho¹, Keun Mo KM Kim¹, Chan Jong CJ Kim¹, Hoon H Kook¹, Tai Ju TJ Hwang¹

¹Department of Pediatrics, Chonnam National University Medical School, Kwangju, Korea

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.

Keywords :Subclavian catheterization, Pediatric patients, Emla