BMC surgery · 2026
Comparative outcomes of central venous access via open jugular and ultrasound-guided subclavian approaches in low-weight pediatric patients: a study with secondary outcomes.
СтатьяРандомизированное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Farhadi Ebrahim, Rezaee Mohsen, Aslanabadi Saeed, Badebarin Davoud, Hamzei Vahid
Аннотация
BACKGROUND: The necessity of this study stems from the lack of comparative evidence on the outcomes of central venous catheterization via the open internal jugular and ultrasound-guided subclavian approaches in low-weight pediatric patients. Its innovation lies in the simultaneous evaluation of both primary and secondary outcomes of these two techniques in this vulnerable population.
METHODS: This prospective randomized clinical trial at Mardani Azar Children's Hospital (winter 2022-2023) included 92 pediatric patients under five kilograms weight, randomly assigned to either open internal jugular or ultrasound-guided subclavian vein catheterization (46 per group). Procedural success and major complications-such as pneumothorax, arterial cannulation, ectopic catheter placement, infection, and thrombosis-were evaluated intraoperatively and during a two-weeks follow-up using imaging and clinical assessment.
RESULTS: The mean catheter placement time was significantly longer in the jugular group than in the subclavian group (41.19 ± 13.8 vs. 33.15 ± 12.12 min; P = 0.04). No cases of pneumothorax, hemothorax, bleeding, arrhythmia, occlusion, infection, or death occurred in either group. Hematoma developed only in the jugular group (6 vs. 0; P = 0.02), and all cases were associated with a procedure duration greater than 35 min (P = 0.041). In the subclavian group, all failures (n = 4) and upper limb edema (n = 3) occurred exclusively in patients under 2.5 kg, with both outcomes significantly linked to lower body weight (P = 0.03 and P = 0.014, respectively). Other complications showed no significant differences between groups.
CONCLUSION: Both approaches were generally safe, with no major adverse events observed in either group. Ultrasound-guided subclavian access was associated with a shorter procedure time, whereas hematoma occurred only in the jugular group and catheterization failure and upper-limb edema were seen only in low-weight infants in the subclavian group. However, because access site and technique were evaluated together, their independent effects could not be determined. In addition, the findings in infants weighing < 2.5 kg were based on few events and should be considered hypothesis-generating rather than definitive.
TRIAL REGISTRATION: This clinical trial was registered in the Iranian Registry of Clinical Trials (IRCT) with the code IRCT20230901059317N1(Registration date: 2024-02-16).
METHODS: This prospective randomized clinical trial at Mardani Azar Children's Hospital (winter 2022-2023) included 92 pediatric patients under five kilograms weight, randomly assigned to either open internal jugular or ultrasound-guided subclavian vein catheterization (46 per group). Procedural success and major complications-such as pneumothorax, arterial cannulation, ectopic catheter placement, infection, and thrombosis-were evaluated intraoperatively and during a two-weeks follow-up using imaging and clinical assessment.
RESULTS: The mean catheter placement time was significantly longer in the jugular group than in the subclavian group (41.19 ± 13.8 vs. 33.15 ± 12.12 min; P = 0.04). No cases of pneumothorax, hemothorax, bleeding, arrhythmia, occlusion, infection, or death occurred in either group. Hematoma developed only in the jugular group (6 vs. 0; P = 0.02), and all cases were associated with a procedure duration greater than 35 min (P = 0.041). In the subclavian group, all failures (n = 4) and upper limb edema (n = 3) occurred exclusively in patients under 2.5 kg, with both outcomes significantly linked to lower body weight (P = 0.03 and P = 0.014, respectively). Other complications showed no significant differences between groups.
CONCLUSION: Both approaches were generally safe, with no major adverse events observed in either group. Ultrasound-guided subclavian access was associated with a shorter procedure time, whereas hematoma occurred only in the jugular group and catheterization failure and upper-limb edema were seen only in low-weight infants in the subclavian group. However, because access site and technique were evaluated together, their independent effects could not be determined. In addition, the findings in infants weighing < 2.5 kg were based on few events and should be considered hypothesis-generating rather than definitive.
TRIAL REGISTRATION: This clinical trial was registered in the Iranian Registry of Clinical Trials (IRCT) with the code IRCT20230901059317N1(Registration date: 2024-02-16).