THE EVALUATION OF PERCUTANEOUS CENTRAL VENOUS CATHETERS - A CONVENIENT TECHNIQUE IN PEDIATRIC-PATIENTS

Objective: To evaluate the feasibility and effectiveness of 3 differen t types of silastic catheters that were used for percutaneous central venous catheterization (PCVC) through peripheral veins. Design and set ting: The study was prospective and consecutive for 6 years at a pedia tric/neonatal intensive care unit and pediatric ward in Veterans Gener al Hospital-Taipei, a university-affiliated medical center, in Taiwan, ROC. Participants and interventions: The patients who had PCVC were c onsecutively enrolled from January 1988 to December 1993. Three types of silastic catheters were used. The classification was according to t he caliber as small catheter (SC, 0.30 mm ID), mid-size catheter (MC, 0.51 mm ID) and large catheter (LC, 0.64 mm ID). The same insertion te chnique, catheter-through-needle, was used for all PCVC placements thr ough the peripheral vein. After insertion, each catheter was connected to a conventional short cannula (24-, 22-, or 20-gauge) of compatible caliber, and then linked to the infusion system. Results: 1318 PCVCs were used in 1126 consecutive patients, that included 754 SCs in 649 i nfants (among them 60.9% were less than 1500 g), 383 MCs in 319 toddle rs, and 181 LCs in 158 children. Mean (SD) body weight at the time of catheter insertion was sc 1.7(0.9) kg, MCV 12.1(6.5) kg and LC 19.3(7. 6) kg. Overall, mean (SD) duration of these PCVC was 16.4(8.4) days. A significantly longer duration was noted in: (a) SC group with 19.7(10 .4) days than the other two groups [MC 12.4(6.5) days, LC 11.2(5.0) da ys]; (b) patients with body weight equal to or less than 3.0 kg [18.7( 8.6) versus 14.1(6.1)]; and (c) insertion sites other than external ju gular vein (EJV) [18.8(9.7) versus 11.7(6.0)]. These PCVCs provided re liable venous access for multiple purposes such as hyperalimentation, venous access or sampling of blood, antibiotic therapy and chemotherap y. MC and LC were also used for monitoring the central venous pressure . Most of the time, SC and MC mere inserted through the superficial pe ripheral vein of the scalp, neck and extremities, while LC was almost approached via the EJV. The overall success rate of insertion was 92.4 % (1318/1427). No significant difference was observed among the differ ent catheter groups [93.4% (754/807) in SC, 90.5% (383/423) in MC and 91.9% (181/197) in LC] and the different insertion sites. Within each group of PCVC, more than eighty percent of catheters were removed elec tively: 83.3% in SC, 89.6% in MC and 84.5% in LC. Probable catheter-re lated sepsis accounted for 2.7% (36/1, 318) of all PCVCs. With this st udy, the cost of each PCVC set is 3.0 US dollars. Conclusion: This stu dy indicates that the use of three different calibers of silastic cath eter is feasible and effective for PCVC in pediatric practice.