Percutaneous subclavian central venous catheterization in children and adolescents: success, complications and related factors.

OBJECTIVE The objective of this study was to investigate the rates of success and of complications of percutaneous subclavian central venous catheterization in children and adolescents and to identify factors associated with them. METHODS This was a study of a series of 204 percutaneous subclavian central venous catheterizations of children and adolescents, using polyvinyl chloride catheters (Intracath(R)), at the Instituto Materno-Infantil Professor Fernando Figueira between December 1, 2003 and April 30, 2004. An analysis was performed of variables related to the patient, such as age, and of variables related to the procedure, such as success/failure, type of anesthesia, complications, who performed the procedure and the number of attempts needed. RESULTS Overall, 89.2% of catheterizations were successful. Percentage success rates were significantly greater when percutaneous subclavian central venous catheterization was performed with the child sedated (94%). Around 43.2% of subclavian catheterizations progressed with complications related to insertion of the catheter; however, complications of greater severity were observed in just 3.5% of cases. There were a greater number of complications related to percutaneous subclavian central venous catheterizations performed by a first-year resident (58.8%), who performed a significantly greater percentage of procedures on children younger than 1 year and who also made a greater number of attempts per patient. CONCLUSIONS The chance of success was greater when patients were sedated for catheterization. There was a greater chance of complications related to insertion of the catheter when percutaneous subclavian central venous catheterization was performed by less experienced physicians, and it would be prudent to designate those central venous catheterizations that present greater risk to surgeons with greater experience.