Abstract：
OBJECTIVE: Central venous catheterization is used widely in critical pediatric patients. The authors sought to compare the success rate and safety of ultrasound-guided subclavian vein cannulation performed via infraclavicular and supraclavicular approaches.
METHODS: The authors compared the success rate of the first puncture and other information for cannulation in the children with congenital heart disease requiring central venous catheterization who were assigned randomly to the supraclavicular approach group (group A) or infraclavicular approach group (group B).
METHODS: Medical university hospital pediatric cardiac intensive care units.
METHODS: Pediatric patients diagnosed with congenital heart disease in the preoperative period who were admitted to the cardiac intensive care unit and required subclavian vein catheterization.
METHODS: Ultrasound-guided subclavian vein cannulation.
RESULTS: Sixty-seven children were included in the study, with 32 in group A and 35 in group B. Notably, there was a significant difference in the success rate of the first puncture between groups A and B (90.6% v 71.4, %, p = 0.047). Furthermore, the access time in group A was 11.8 seconds (3.2-95), which was significantly shorter than that in group B (16.0 [6.5-227] seconds, p = 0.001). In addition, the catheter malposition rate in group A was significantly lower than that in group B (0% v 11.4%, p = 0.049). Conversely, there were no significant differences in the total access time, overall success rate, and complications (eg, pneumothorax, hemorrhage, puncture artery, and nerve injury) between the 2 groups.
CONCLUSIONS: For children with congenital heart disease requiring central venous catheterization during the perioperative period, the subclavian vein is a feasible site for catheterization. The supraclavicular approach, especially the left side, has a higher first-puncture success rate, shorter access time, lower complications, and a trend of lower incidence of catheter malposition. However, a larger sample size of a randomized controlled study is expected to verify the advantages of ultrasound-guided subclavian catheterization in children.
METHODS: The authors compared the success rate of the first puncture and other information for cannulation in the children with congenital heart disease requiring central venous catheterization who were assigned randomly to the supraclavicular approach group (group A) or infraclavicular approach group (group B).
METHODS: Medical university hospital pediatric cardiac intensive care units.
METHODS: Pediatric patients diagnosed with congenital heart disease in the preoperative period who were admitted to the cardiac intensive care unit and required subclavian vein catheterization.
METHODS: Ultrasound-guided subclavian vein cannulation.
RESULTS: Sixty-seven children were included in the study, with 32 in group A and 35 in group B. Notably, there was a significant difference in the success rate of the first puncture between groups A and B (90.6% v 71.4, %, p = 0.047). Furthermore, the access time in group A was 11.8 seconds (3.2-95), which was significantly shorter than that in group B (16.0 [6.5-227] seconds, p = 0.001). In addition, the catheter malposition rate in group A was significantly lower than that in group B (0% v 11.4%, p = 0.049). Conversely, there were no significant differences in the total access time, overall success rate, and complications (eg, pneumothorax, hemorrhage, puncture artery, and nerve injury) between the 2 groups.
CONCLUSIONS: For children with congenital heart disease requiring central venous catheterization during the perioperative period, the subclavian vein is a feasible site for catheterization. The supraclavicular approach, especially the left side, has a higher first-puncture success rate, shorter access time, lower complications, and a trend of lower incidence of catheter malposition. However, a larger sample size of a randomized controlled study is expected to verify the advantages of ultrasound-guided subclavian catheterization in children.
摘要：
目的：中心静脉置管广泛应用于危重患儿。作者试图比较通过锁骨下和锁骨上入路进行超声引导锁骨下静脉插管的成功率和安全性。
方法：作者比较了需要中心静脉置管的先天性心脏病患儿的首次穿刺成功率和其他插管信息，这些患儿被随机分配到锁骨上入路组（A组）或锁骨下入路组（B组）。
方法：医科大学附属医院儿科心脏重症监护病房。
方法：术前诊断为先天性心脏病的儿科患者，入院心脏重症监护病房并需要锁骨下静脉置管。
方法：超声引导锁骨下静脉置管。
结果：67名儿童被纳入研究，A组32，B组35，值得注意的是，A组和B组首次穿刺成功率差异有统计学意义(90.6%v71.4%,p=0.047)。此外，A组的访问时间为11.8秒（3.2-95），明显短于B组（16.0[6.5-227]秒，p=0.001)。此外,A组的导管错位率明显低于B组(0%v11.4%,p=0.049)。相反，总访问时间没有显着差异，总体成功率,和并发症(例如，气胸,出血,穿刺动脉,和神经损伤）。
结论：对于围手术期需要中心静脉置管的先天性心脏病患儿，锁骨下静脉是导管插入的可行部位.锁骨上入路,尤其是左边,有较高的首次穿刺成功率，更短的访问时间，并发症较低，导管错位的发生率有降低的趋势。然而,一项随机对照研究的更大样本量有望验证超声引导下锁骨下导管插入术在儿童中的优势.
方法：作者比较了需要中心静脉置管的先天性心脏病患儿的首次穿刺成功率和其他插管信息，这些患儿被随机分配到锁骨上入路组（A组）或锁骨下入路组（B组）。
方法：医科大学附属医院儿科心脏重症监护病房。
方法：术前诊断为先天性心脏病的儿科患者，入院心脏重症监护病房并需要锁骨下静脉置管。
方法：超声引导锁骨下静脉置管。
结果：67名儿童被纳入研究，A组32，B组35，值得注意的是，A组和B组首次穿刺成功率差异有统计学意义(90.6%v71.4%,p=0.047)。此外，A组的访问时间为11.8秒（3.2-95），明显短于B组（16.0[6.5-227]秒，p=0.001)。此外,A组的导管错位率明显低于B组(0%v11.4%,p=0.049)。相反，总访问时间没有显着差异，总体成功率,和并发症(例如，气胸,出血,穿刺动脉,和神经损伤）。
结论：对于围手术期需要中心静脉置管的先天性心脏病患儿，锁骨下静脉是导管插入的可行部位.锁骨上入路,尤其是左边,有较高的首次穿刺成功率，更短的访问时间，并发症较低，导管错位的发生率有降低的趋势。然而,一项随机对照研究的更大样本量有望验证超声引导下锁骨下导管插入术在儿童中的优势.
