• Serge Malbezin, Tobias Gauss, Ian Smith, Beatrice Bruneau, Nyamjargal Mangalsuren, Thierno Diallo, Alia Skhiri, Yves Nivoche, Souhayl Dahmani, and Christopher Brasher.
• Department of Anesthesiology and Intensive Care, Robert Debré University Hospital, AP-HP, Paris, France; Université René Diderot (Paris VII), PRES Sorbonne Paris Cite, Paris, France.
• Paediatr Anaesth. 2013 Nov 1;23(11):974-9.

ObjectiveTo review the results of an anesthesiologist led pediatric percutaneous central venous access service.MethodsProspective data on percutaneous pediatric central venous catheter (CVC) insertions were collected over 22 years. Data included age, gender, weight, previous central CVCs, venous thromboses, investigations for great vein patency, type of CVC, external diameter, previous CVC insertions, intended use, operator identity, and the vein into which the CVC was inserted. The default technique was internal jugular vein cannulation using landmark technique (LT). Complication was defined as the following: failure to cannulate any vein, hemothorax, pneumothorax, right atrial perforation, extravenous wire positioning or CVC position and whether the patient was taken back to theater for CVC repositioning.ResultsFive thousand four hundred and thirty-four percutaneous CVC insertion procedures were performed on 3954 patients. One-third involved children <1 year of age (n = 1823: 34%). Five thousand one hundred and twenty-five CVCs (95.3%) were inserted into internal jugular veins. The majority were tunneled CVCs (n = 5190: 96.2%). The perioperative complication rate was 1.3%. Successful cannulation occurred in 99.5% of patients. Failure was more likely in children <3 kg, during large bore hemodialysis CVC insertions and during the first 4 years of the service - the latter suggesting a learning curve. Ninety-nine percent of CVCs were inserted using LTs.ConclusionThis study demonstrates a high success rate and low complication rate during pediatric percutaneous internal jugular vein CVC insertions by trained anesthesiologists using LTs. Smaller children, hemodialysis CVCs, and the team's learning curve were identified as risk factors for insertion failure.© 2013 John Wiley & Sons Ltd.

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