Hickman central venous catheters in children: open versus percutaneous technique

Osama A Bawazir, Tariq I Altokhais
Annals of Vascular Surgery 2020 May 16

BACKGROUND: The ideal technique for insertion of tunneled central venous catheters (CVCs) in children is still debatable. This study aimed to compare the outcomes of open versus percutaneous technique for the insertion of tunneled CVCs.

METHODS: The study included 279 patients who had CVCs insertions from 2010 to 2020. Patients were divided into two groups according to the technique of insertion; group 1 (n= 90) included patients who had the open cut-down method, and group 2 (n= 189) included patients who had the percutaneous technique.

RESULTS: There was no difference in age and gender distribution between groups (p= 0.152 and 0.102, respectively). Chemotherapy was the most common indication of insertion (77 (85.56%) vs. 165 (87.30%); in group 1 vs. 2, p= 0.688). The left external jugular was the most common site of insertion in group 1 (n= 66; 73.33%), and the left subclavian was the most common site in group 2 (n= 77; 40.74%). Complications of insertion were non-significantly higher in group 2 (p= 0.170). Nine patients in group 2 required conversion to cut-down technique (4.76%). Complications during removal were non-significantly higher in group 2 (p= 0.182) and the most common was bleeding (n= 4; 2.12%). The most common indication for catheter removal was the completion of the treatment (36 (40%) vs. 85 (44.97%) in groups 1 and 2; respectively).

CONCLUSION: Percutaneous and open tunneled central venous catheter insertion are safe in pediatric patients who require long-term venous access. Both techniques have a low complication rate. The choice of each method should be tailored to the condition of each patient.

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