Background
Central venous access is indispensable for clinical management of pediatric patients with hematological disorders, including chemotherapy administration, blood product transfusion, and critical rescue. Repeated venipuncture attempts, procedural failure, postoperative catheter malposition, and cannulation-related complications can substantially disrupt subsequent treatment courses and compromise therapeutic efficacy.
Aims
This retrospective study aimed to evaluate the feasibility and safety of ultrasound-guided brachiocephalic vein (BCV) cannulation, with the goal of optimizing central venous catheterization protocols, reducing procedure-related adverse events, and improving the efficiency and safety of treatment via central venous access in pediatric patients.
Methods
This retrospective study included 580 children (303 subclavian vein [SCV], 277 BCV) who underwent ultrasound-guided central venous catheterization between January 2021 and December 2024. We compared first-attempt success rate, overall success rate, procedural duration, intraoperative adverse events, postoperative complications, and catheter malposition. Inverse probability of treatment weighting (IPTW) was used to improve comparability between the groups with respect to measured baseline covariates. Multivariable logistic regression identified independent risk factors.
Results
After IPTW, the BCV approach was associated with a higher first-attempt success rate (OR = 1.72, 95% CI: 1.05–2.81; risk difference [RD] = 0.119, 95% CI: 0.015–0.222) and a higher overall success rate (RD = 0.091, 95% CI: 0.013–0.168). The mean procedural duration was 6 min shorter in the BCV group (95% CI: −9.5 to −2.5). The BCV approach was independently associated with lower odds of intraoperative malposition (OR = 0.096, 95% CI: 0.037–0.249), postoperative malposition (OR = 0.34, 95% CI: 0.16–0.74), and perioperative complications (OR = 0.28, 95% CI: 0.08–0.94). Multivariable regression analysis showed that catheterization approach was independently associated with catheter malposition.
Conclusions
Compared with SCV, ultrasound-guided BCV cannulation is associated with higher success rates, shorter procedural duration, and fewer malpositions and complications. This technique may offer particular benefits for children with hematological disorders.
Clinical Implications
What is already known
Ultrasound-guided brachiocephalic vein (BCV) cannulation is a feasible and safe rescue modality for critically ill children, neonates, and preterm infants when conventional vascular access cannot be established. However, high-quality evidence supporting its use in pediatric patients with hematological disorders remains scarce.
What new information this study adds
This large retrospective comparative study demonstrated that, in pediatric patients with hematological disorders, the ultrasound-guided supraclavicular BCV approach was associated with higher first-attempt success rates and lower incidences of perioperative complications and catheter malposition compared with the subclavian vein (SCV) approach. These findings support the BCV approach as a favorable option for routine vascular access in this vulnerable population.