CONFIRMATION OF THE SAFETY OF CENTRAL VENOUS CATHETERIZATION IN CRITICALLY ILL INFANTS AND CHILDREN - THE BARAGWANATH EXPERIENCE

Objective. To evaluate, in critically ill children, the safety and eff ectiveness of routine central venous catheterisations (CVCs) performed by residents from all disciplines. Design. Prospective audit of all C VCs over a 24-month period, Setting Multidisciplinary intensive care u nit at Baragwanath Hospital, Soweto,Patients. All critically ill patie nts 12 years of age or younger requiring CVC., All percutaneous sites (subclavian, internal jugular and femoral) were used; these were selec ted by the attending doctor and not influenced by the audit.Results. T here were 272 catheterisation attempts, of which 241 (88.6%) were succ essful, Patient age and size but not disease severity influenced incid ences of both catheterisation failure and minor bleeding. The latter w as the commonest early complication, occurring in 63 (23.2%) successfu l catheterisations, There were 7 major complications - 3 pneumothorace s, 2 tachyarrhythmias and 2 major bleeds, all with subclavian vein cat heterisation. Catheter-related infections (CRIs) occurred in 85 (51.2% ) of 166 lines and catheter-related septicaemia (CRS) in 10 (5.7%) of 175 lines where there were sufficient data for evaluation. No patient or line factor, including duration of insertion, influenced CRI or CRS , In CRI, Staphylococcus epidermidis was the commonest organism, Other common CRI isolates were Enterococcus faecalis, Klebsiella spp. and C andida albicans, Six different organisms were implicated in CRS. Concl usions. GVC is a safe procedure with a high success rate. The femoral vein is the recommended percutaneous site of choice as it carries no g reat risk of sepsis and does not expose the patient to the hazard of i ntrathoracic complications.