Comparison of Open and Ultrasound-Guided Placement of Central Venous Catheter in Children Weighing Less Than Five Kilograms; A Randomized Clinical Trial

Objectives: Ultrasound is currently utilized to locate the internal jugular vein (IJV), reduce the complications of catheter placement, and increase the likelihood of accessing IJV. Therefore, the aim of the present study was to evaluate the effectiveness of ultrasound in reducing complications during catheter placement in children weighing less than 5 kg.

Materials and methods: The current randomized clinical trial was performed on 111 children weighing less than 5 kg who required a central venous catheter (CVC). Children were divided into two groups: in the first group (Seldinger group; n = 55), a CVC was inserted using the Seldinger wire method under ultrasound guidance, and in the second group (open surgical cutdown (OSC); n = 56), the catheter was inserted via the open method. Two weeks after catheter placement, patients were evaluated for thrombosis, catheter occlusion, catheter tip migration, infection, catheter removal, and catheter dysfunction.

Results: The success rate of catheter placement in the ultrasound-guided method was 85.5%. The incidence of thrombosis (3.6% vs. 5.4%), infection (1.8% vs. 7.4%), and bleeding (zero vs. 3.6%) was lower in the Seldinger group, but the difference was not significant (p ˃ 0.05). Hematoma (7.3% vs. 3.6%) occurred less frequently in the patients of the OSC group (p = 0.33). Hemothorax, pneumothorax, catheter migration, and occlusion did not occur in any of the patients. In the OSC group, two deaths (3.6%) occurred due to underlying diseases.

Conclusion: When ultrasound is used to insert a CVC in children weighing less than 5 kg, the incidence of complications is not significantly different compared to when the open method is employed.