191 CENTRAL VENOUS CATHETER INSERTION VIA FEMORAL VEIN BY PEDIATRIC RESIDENTS: A SAFE AND EFFECTIVE TECHNIQUE

Abstract

Success in teaching pediatric residents (PRs) to insert central venous catheters (CVCs) for hemodynamic monitoring has not been evaluated previously. Surveillance was carried out for CVCs inserted by PRs under the supervision of ICU attendings or chief residents, using the percutaneous Seldinger technique via the femoral vein. Insertion by PRs or ICU staff was successful in 21 of 23 (91%) consecutive patients attempted. Success was achieved in a single attempt in 13 of 21 cases; the others required 3–8 attempts. In successful cases, insertions required ≤5 minutes in 12 of 20 (60%) for whom time was recorded. Patients ≤10kg had prolonged (>5 minutes) or unsuccessful attempts (6 of 8) more often than patients >10kg (4 of 14) (p=.048). PRs were successful in 14 of 21 (67%) patients attempted, and were successful at the first insertion attempt in 12 of 21 (57%). Most of the PRs (15 of 18) had previously inserted fewer than 5 CVCs each. The only significant complication, arterial puncture in 2 of 23 (9%), was not associated with sequela. Minor complications included mild local bleeding (3), transient pallor of leg (1), catheter looped in vena cava (easily repositioned) (1), and thrombi adhering to the catheter at post mortem exam (2). Clinical evidence of venous obstruction was not observed. CVC insertion by femoral vein is a safe and effective procedure. Instruction in this procedure should be included in pediatric advanced life support training for pediatric residents.

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