Uses and complications of central venous catheters inserted in a pediatric emergency department

Objective: To describe the incidence, indications, insertion sites, duration, and complications of central venous catheter (CVC) insertion in patients in a pediatric emergency department (ED). Methods: Design: Retrospective chart review. Setting: ED of an urban pediatric teaching hospital, Subjects: Patients who had a CVC inserted in the ED from January 1992 to July 1997. Results: During the 5.5-year study period, 121 patients were identified. Indications for insertion were cardiac/respiratory arrest in 20 patients (17%), lack of peripheral vascular access in 78 (64%), and inadequate peripheral vascular access in 23 (19%). Presenting diagnoses included cardiac/respiratory arrest (20), dehydration (19), lower respiratory tract disease (15), seizure (15), sepsis (13), trauma (10), and other (29), Prior to the CVC insertion, 80 (66%) patients had no venous access, 28 (23%) had a peripheral intravenous catheter, and 13 (11%) had an intraosseous needle. One hundred one (83%) CVCs were inserted into the femoral vein, 12 (10%) into the subclavian, 7 (6%) into the internal jugular, and 1 (1%) into an axillary vein. There were four reported complications requiring the CVC to be removed, and all occurred with femoral line placement. There were no long-term sequelae or life-threatening or limb-threatening complications (95% CI = 0-2.5%). Conclusions: Central venous catheterization, particularly using the femoral approach, appears to a safe method of obtaining central venous access in the critically ill infant, child, or young adult.