Comparison of the efficiency of anatomical marking and ultrasound-guided central venous catheter insertion methods in pediatric patients

Objective: It is aimed to show the superiority of ultrasonography-guided interventions over the traditional landmark technique in providing vascular access through central venous catheters in critical pediatric patient care, and to show that ultrasound (US) can be used for this procedure even with a short training. Material and Method: It was designed as a single-center, prospective randomized control group study. In this study, 93 critically ill children aged 1 month - 18 years, who were hospitalized in Manisa Celal Bayar University Hospital's second and tertiary level pediatric intensive care units between March 15, 2020 and June 15, 2022 were included. The data of 50 patients who had a central venous catheter inserted by one pediatric intensive care specialist between March 15, 2020 and January 1, 2021 were included in the study retrospectively. After the arrival of US, which was provided by the Scientific Research Projects infrastructure, between January 1, 2021 and June 15, 2022, 43 patients who had a central venous catheter inserted by the same pediatric intensive care specialist with the ultrasonographic imaging performed by a pediatrics resident who received a 2-day US course, were included in the study. Demographic information, duration of intervention and complications were noted in the study form. Statistical data analysis was performed with SPSS software. Results: Out of 93 cases in the study, 43 catheters were inserted using US, and 50 catheters were inserted using landmark technique. Interventions with US, compared to the landmark technique, were found to be more successful (75.3% versus 72% p=0.003), the need for more than one intervention was less frequent (22% vs. 62.8%, p<0.001), the first puncture times were shorter (mean 10 seconds vs. 45 seconds, p<0.001) and the interventions took shorter times (average 120 seconds vs 300 seconds, p<0.001). The rate of hematoma was found to be less in interventions performed with US (2.3% vs. 14%, p=0.045). Conclusion: It has been observed that the duration of intervention is shortened, the need for re-intervention is reduced, and anatomical variations and thrombosed vessels can be visualized and avoided with ultrasonography. We recommend that all physicians dealing with critically ill pediatric patients to receive a short-term training and to use ultrasonography in their daily practices and interventional procedures.