Use of real-time ultrasound during central venous catheter placement: Results of an APSA survey

Melvin S Dassinger; Elizabeth J Renaud; Adam Goldin; Eunice Y Huang; Robert T Russell; Christian J Streck; Xinyu Tang; Martin L Blakely

doi:10.1016/j.jpedsurg.2015.03.003

Use of real-time ultrasound during central venous catheter placement: Results of an APSA survey

J Pediatr Surg. 2015 Jul;50(7):1162-7. doi: 10.1016/j.jpedsurg.2015.03.003. Epub 2015 Mar 13.

Authors

Melvin S Dassinger¹, Elizabeth J Renaud², Adam Goldin³, Eunice Y Huang⁴, Robert T Russell⁵, Christian J Streck⁶, Xinyu Tang⁷, Martin L Blakely⁸

Affiliations

¹ Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR. Electronic address: dassingermelvins@uams.edu.
² Albany Medical Center, Albany, NY.
³ Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA.
⁴ University of Tennessee Health Sciences Center, Memphis, TN.
⁵ Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL.
⁶ Medical University of South Carolina, Charleston, SC.
⁷ Biostatistics Program, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
⁸ Monroe Carell Jr Children's Hospital, Vanderbilt University Medical Center, Nashville, TN.

PMID: 25783346
DOI: 10.1016/j.jpedsurg.2015.03.003

Abstract

Purpose: The purpose of this study was to document the attitudes and practice patterns of pediatric surgeons regarding use of RTUS with CVC placement.

Methods: An analytic survey composed of 20 questions was sent via APSA headquarters to all practicing members. Answers were summarized as frequency and percentage. Distributions of answers were compared using the chi-square tests. P-values ≤0.05 were considered statistically significant.

Results: 361 of 1072 members chose to participate for a response rate of 34%. Most placed CVCs into the subclavian veins (SCV) of patients without coagulopathy, with the left SCV chosen approximately four times more often than the right. Conversely, RTUS use at the internal jugular vein (IJV) was significantly greater than that for the SCV (p<0.001). Coagulopathy, multiple previous catheters, and morbid obesity were identified as patient characteristics that would encourage RTUS use. The most commonly cited potential barriers to RTUS use were lack of formal ultrasound training and the belief that ultrasound is not necessary.

Conclusions: Variability exists among pediatric surgeons regarding use of RTUS during CVC placement. Additional studies are needed to document actual frequency of use, how RTUS is implemented, and its efficacy of preventing adverse events in children.

Keywords: Catheter; Real-time; Survey; Ultrasound; Venous.

MeSH terms

Catheterization, Central Venous / methods
Catheterization, Central Venous / statistics & numerical data*
Central Venous Catheters*
Chi-Square Distribution
Female
Humans
Jugular Veins*
Male
Pediatrics / statistics & numerical data*
Subclavian Vein*
Surveys and Questionnaires
Ultrasonography, Interventional*