A comparative study between open and transdermal technique of placing central venous catheters in pediatric patients

Doctoral Dissertation uoadl:3389079 11 Read counter

Faculty of Medicine
Library of the School of Health Sciences
Deposit date:
Noutsos Georgios
Dissertation committee:
Καττάμης Αντώνιος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κανακά – Gantenbein Χριστίνα Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Χατζηιωάννου Αχιλλέας Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Σιαχανίδου Σουλτάνα Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Μίχος Αθανάσιος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Καδίτης Αθανάσιος Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Σπηλιόπουλος Σταύρος Επίκουρος καθηγητής, Ιατρική σχολή, ΕΚΠΑ
Original Title:
Συγκριτική μελέτη μεταξύ ανοικτής και διαδερμικής τεχνικής τοποθέτησης κεντρικών φλεβικών καθετήρων σε παιδιατρικούς ασθενείς
Translated title:
A comparative study between open and transdermal technique of placing central venous catheters in pediatric patients
The placement of long-term central venous catheters is one of the most common interventions that take place in the operating room and the Intensive Care Unit. In pediatric patients, the indications for their placement vary and range from the administration of parenteral nutrition and long-term oncological therapies to bone marrow transplantation. However, their placement is associated with immediate and long-term complications. Long-term complications, such as infection, dysfunction and thrombosis can lead to vessel occlusion and premature removal of the central venous catheter. Several factors are associated with the duration of the long-term central venous catheter in pediatric oncological hematologic patients. These factors are associated with the patient, the type of central venous catheter, the vessel being catheterized, the type of therapy administered, and the technique used for their placement. Tunneled Hickman’s catheters and implantable venous access devices are used for administration of chemotherapy, total parenteral nutrition, or replacement of factors in children. Traditionally these are inserted by open surgical technique through a venotomy or percutaneously using landmark technique or under ultrasound guidance. Recently ultrasound guided percutaneous access is being used increasingly and is recommended as the procedure of choice for central venous access. Ultrasound guided insertion of central lines has proven to be safe and minimizes complications associated with blind needle punctures. It has been accepted as standard of practice for adults, its practice in pediatrics is not universal. It has been demonstrated that US technique had lesser operating time and no increase in complication rates despite operators of varying experience performing the procedures. Simulation training, anatomic models, supervised insertions, and objective competency criteria have shown to reduce complications from US guided technique. In the present study, the three most commonly applied techniques for the placement of partially implantable central venous catheters were compared. These are the percutaneous landmark-guided technique, the ultrasound-guided percutaneous technique and the open surgical technique. These techniques were evaluated for their safety and effectiveness. The results of the present study showed that the ultrasound-guided percutaneous technique is a safe alternative placement technique, which is less time-consuming, without serious complications, and protects the anatomy of the recipient vessel. Therefore, this technique should be recommended for the insertion of indwelling central venous catheters, especially in the pediatric population.
Main subject category:
Health Sciences
Pediatric patients, Central venous catheters, Ultrasound guided, Percutaneous techniques, Placement, Surgical techniques
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