Evaluation of Mechanical Complications During Pediatric Central Venous Catheter Placement from 1994 to 2013 - Pages 36-46
Kenji Kayashima and Keiko Imai
Department of Anesthesia, Kyushu Kosei Nenkin Hospital, 1-8-1 Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka 806-8501, Japan
Pediatric central venous catheter placement could be associated with mechanical complications. Knowledge of detailed information described in case reports on such mechanical complications can help improve patient safety. Through an extensive literature search for case reports in PubMed and other databases from 1994 to 2013, 86 cases (from 63 articles) of mechanical complications related to pediatric central venous catheter placement were identified. Of the 86 patients, 22 died: 16 had tamponade; 3 had malposition, including migration, extravasation, and dislodgement; 1 had arterial puncture; 1 had hemothorax; and 1 had cardiac perforation. Cardiac tamponade was reported more frequently when umbilical catheters were used (23 cases) compared to cases where catheters were inserted at 13 other sites. Most of the cases of cardiac tamponade appeared to be related to the location of the catheter tip in the right atrium. Mechanical complications may lead to life-threatening outcomes. Therefore, the location of the tip of the central venous catheter should be assessed immediately after insertion, particularly in neonates, and any signs of abnormality should be identified as soon as possible to ensure appropriate management. Thus, we believe that awareness of the details of case reports on mechanical complications related to central venous catheter placement in children could help reduce the unfavorable outcomes.
Keywords: Pediatrics, Central venous catheters, Complication, Cardiac tamponade.