Kritik Hasta Çocuklarda Ultrason Eşliğinde Santral Venöz Kateterizasyonun Komplikasyonlar ve Başarı Oranına Etkisi: Çok Merkezli Çalışma

Abstract

Amaç: Bu çalışmada çocuk yoğun bakım ünitelerinde ultrasonografi eşliğinde yapılmış olan santral venöz kateter uygulamalarının değerlendirilmesi ve ultrason kullanılmadan takılan kateterizasyonlarla karşılaştırılması amaçlanmıştı. Gereç ve Yöntemler: Hastalar, kullanılan tekniğe göre iki gruba ayrıldı: Ultrason kullanılmayan hasta grubu (459 hasta) ve US kullanılan hasta grubu (200 hasta). Başarı oranını, girişim sayısını ve komplikasyon oranlarını her hastanın yaşına ve kilosuna göre değerlendirdik. Bulgular: SVK’nın başarılı bir şekilde yerleştirilmesi için gereken süre iki grup arasında önemli ölçüde farklıydı: Ultrason kullanılmayan grupta 10.9±10.8 dakika ve ultrason kılavuzluğundaki grupta 8.1±7.6 dakika (p=0.012). Ek olarak, başarılı kateterizasyon için ortalama girişim sayısı, ultrason kılavuzluğundaki grupta 1.8±0.8’di; ultrason kullanılmayan grupta 2.5±1.4 (p=0.024). Toplam 115 (%17.3) komplikasyon kaydedildi: Ultrason kullanılan grupta 24 (%3.6) ve ultrason kullanılmayan grupta 91 (%13.7) (p=0.014). Hastaların yaşı ve kilosu arttıkça komplikasyon sıklığı azaldığı saptandı. Ultrason kullanılarak takılan kateterler değerlendirildiğinde %59.5’inin ultrason eğitimi almış klinisyenler tarafından, %40.5’inin ultrason eğitimi almamış klinisyenler tarafından yerleştirildiği görüldü. Ultrason eğitimi almış ve almamış klinisyenler arasında komplikasyon oranı, girişim sayısı ve başarı oranları açısından anlamlı fark yoktu (p=0.476). Sonuç: Çalışmamız çocuklarda ultrason eşliğinde ve ultrason kullanılmadan SVK yerleştirmesini karşılaştıran en büyük çok merkezli çalışmadır. Ultrason eşliğinde takılan SVK işleminin daha güvenli ve daha az zaman aldığına inanıyoruz. Ayrıca, yatakbaşı ultrason pediatrik yoğun bakım uzmanları için yararlı ve kolayca elde edilebilir bir yöntemdir.

Keywords

• Santral venöz kateter
• ultrason
• çocuk yoğun bakım

The Effect of Ultrasound-guided Central Venous Catheterization on Complications and Success Rate in Critically Ill Children: A Multicenter Study

Abstract

Objective: The aims of this study were to compare the results of ultrasound (US) guidance and the landmark (LM) technique for central venous catheter (CVC) placement in pediatric intensive care units (PICUs) as performed by clinicians. Material and Methods: The patients were divided into two groups according to the technique used: an LM group (459 patients) and a US-guided group (200 patients). We evaluated the success rate, the number of attempts, and the complication rates based on each patient’s age and weight. Results: The time required for the successful placement of the CVC was significantly different between the two groups: 10.9±10.8 min in the LM group and 8.1±7.6 min in the US-guided group (p=0.012). Additionally, the average number of attempts for successful catheterization was 1.8±0.8 in the US-guided group; and 2.5 ± 1.4 in the LM group (p=0.024). A total of 115 (17.3%) complications were noted: 24 (3.6%) in the US-guided group and 91 (13.7%) in the LM group (p=0.014). The frequency of complications decreased as the age and weight of the patients increased. When the inserted catheters used by ultrasound were evaluated, 59.5% of them were placed by clinicians who had ultrasound training while 40.5% were inserted by clinicians who did not have ultrasound training. There was no significant difference in the complication rate, number of punctures, and success rates between the ultrasound-trained and untrained clinicians (p=0.476). Conclusion: This is the largest multicenter study comparing the US-guided vs. LM technique for CVC placement in children. We believe that the US-guided CVC procedure is more safe and takes less time than the LM technique. Also, point-of-care ultrasound is useful, beneficial, and easily available for pediatric intensivists.

Keywords

• Central venous catheter
• ultrasound
• pediatric intensive care

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