Risk factors for a failed first attempt at pediatric subclavian central venous catheters and the role of single-attempt placement in reducing catheter-related morbidity: a prospective observational study

Introduction: The aim of this observational study was to investigate the risk factors of a failed first attempt at pediatric central venous catheter (CVC) placement and its impact on CVC-related morbidity.

Materials and methods: In this prospective observational study, we included 3-month-to 5-year-old children proposed for infraclavicular subclavian vein catheterization consecutively sing the anatomic landmark technique. Patients were divided into two groups: group 1 included single-attempt catheter placements, and Group 2 included failed first attempts at catheter placement. The management protocol was standardized for all patients. After comparing the two groups, univariable logistic regression was used to investigate the risk factors for a failed first attempt and to show the interest of the single-attempt catheter placement.

Results: Among 150 pediatric CVC placements, the incidence of failed first attempts was 41.3% and its main risk factors were children with comorbidities (OR=3.11; 95%CI: 1.17-8.21), hematology and oncology patients (OR=5.6; 95%CI: 2.75-11.38), children with aplastic anemia (OR=3.05; 95%CI:1.388-6.705), and anesthesia sedation with I-Gel airway ventilation (OR=9.21; 95%CI: 1.080-78.5). On the other hand, a single-attempt catheter placement was a protective factor against catheter-related complications with OR=0.258 [0.12-0.55].

Conclusion: It seems that a single-attempt CVC placement may reduce the incidence of complications. The knowledge of the main risk factors of failed first attempts is mandatory for taking necessary precautions.