The Feasibility of Ultrasound to Assess Subglottic Diameter

Abstract

C atheter-associated infections and tip contamination were compared between percutaneously placed central venous catheters in the internal jugular and subclavian veins in surgical neonates undergoing major noncardiac surgery. Two hundred ninety-five prospectively computerized protocols of 295 procedures were retrospectively analyzed. One hundred twenty-nine internal jugular venous (group I) and 107 subclavian venous (group S) catheters were included. The median postconceptional age was 37 weeks in group I and 38 weeks in group S. Neonatal weights ranged from 580 g to 4.5 kg in group I and from 820 g to 4.5 kg in group S at the time of insertion. Markedly more catheter-associated infections were seen in group I (15.5% vs. 4.7%). The internal jugular venous catheters were also associated with a markedly increased probability of an earlier onset of catheter-associated infection compared with the subclavian venous catheters. This probability was slightly increased by a lower weight and was not increased by a lower age. Notably more catheter tips were contaminated by pathogens in group I (55.8% vs. 33.6%). The internal jugular venous catheters were associated with a higher infection rate as well as earlier onset of catheter-associated infection compared with subclavian venous catheters. COMMENTThere have been studies in adults which have shown that percutaneously placed central venous catheters in the internal jugular vein have a higher complication rate than catheters placed in the subclavian vein. This story replicates those studies in a pediatric population. In the neonatal intensive care, infants with a central venous catheter have an incidence of bloodstream infection 4 times higher than infants without catheters.A total of 295 procedures were retrospectively reviewed. These were catheters percutaneously placed for noncardiac surgery in neonates in the first month of life. All were placed in the operating room with routine aseptic precautions, including chlorhexidine/alcohol skin preparation. Only infants weighing <4.6 kg were included. Untunneled catheters were placed by the Seldinger technique using a 2F single lumen (for <1.9 kg) or a 4F double lumen (>1.9 kg) catheter and covered with a clear plastic dressing (>1 kg) or Steri-strips (<1 kg). The smallest infant was 580 g! Fifty-two procedures were excluded because catheter tip culture results were not available, and catheter placement was unsuccessful in 7 children. There were 129 internal jugular and 107 subclavian catheters. The study was retrospective and unblinded, so the internal jugular group ended up somewhat smaller than the subclavian group, or as I read it, the subclavian group was larger because who wants to stick a subclavian vein in a tiny baby?Twenty-nine percent of internal jugular catheters needed to be removed prematurely because of complications versus 15% of the subclavian catheters. Infections and suspected infections were the most common reasons for premature catheter removal. The next most common reason was catheter kinking. This was obs...