Wen-Hsien Lu

Supraclavicular versus Infraclavicular Subclavian Vein Catheterization in Infants

Background: Central venous catheterization is an important procedure for infant patients for a number of different purposes, including nutritional support, surgical operation, hemodynamic monitoring, and multiple lines for critical care medications. Subclavian vein catheterization (SVC) is one of the central vein catheterization techniques. SVC can be performed from 4 different locations: right supraclavicular (RSC), left supraclavicular (LSC), right infraclavicular (RIC), and left infraclavicular (LIC). The purpose of this study was to evaluate the relative effectiveness and complication risks of these 4 SVC locations in infants. Methods: In our pediatric intensive care unit, which is part of a tertiary medical center, a well‐trained fellow doctor performed the following catheterizations: 21 RSC, 24 LSC, 24 RIC, and 22 LIC, for a total of 91 SVC operations in infants. The patients were placed in the Trendelenburg position. The site of puncture was decided by the operator. Statistical significance was analyzed according to Fishers exact test and 2‐sample t test. Results: The overall success rate was 90.1% (82 out of 91 operations). No statistically significant differences were noted among these 4 groups, either in the success or complication rate. There were 6 cases of arterial puncture (5 supraclavicular and 1 infraclavicular, p = 0.09), 2 cases of pneumothorax (1 RSC and 1 RIC), and 2 cases of malpositioned catheter (1 RSC and 1 RIC). There was no mortality. Conclusion: In our study, we found that there was no statistically significant difference among the 4 SVC locations in effectiveness of operation or in risk of complication. There was a tendency to damage the subclavian arteries through the supraclavicular route.

Subclavian Central Venous Catheterization in Infants with Body Weight Less Than 10 kg

Central venous access is an important aspect of medical treatment in intensive care units. We frequently require central venous catheterization (CVC) for total parenteral nutrition (TPN), intravenous antibiotics, multiple transfusions, and chemotherapy. The primary aim of this study is to demonstrate that percutaneous central venous catheterization in patients with body weight (BW) less than 10 kg can be conducted by the subclavian vein rather than the traditional femoral vein. Between January 1998 and December 2003, we performed 70 subclavian vein catheterizations (SVCs) in 46 patients with BW less than 10 kg in the pediatric intensive care unit (PICU) of a tertiary medical center. We divided patients according to their body weight into two groups, BW less than 5 kg and BW between 5 and 10 kg. We found SVC had a high total success rate, 92.9% (65/70), for the whole group. Success rate was 83.3% (15/18) for the BW less than 5 kg group and 96.2% (50/52) for the BW 5-10 kg group. In this study we found percutaneous subclavian venous catheterization in children with BW below 10 kg to be a relatively safe procedure with low risk of complication and no risk of mortality.

A potentially fatal complication during subclavian vein catheterization in an infant with congenital heart disease—puncture to pulmonary artery directly: a case report

The most frequent and acute complications of subclavian vein catheterization are arterial puncture to the subclavian artery and pneumothorax. We report an arterial puncture directly to the pulmonary artery in infant during subclavian vein catheterization.

Isolated Complete Agenesis of Corpus Callosum

Agenesis of corpus callosum (ACC) often accompanies other neural migration disorders and its prognosis must take these disorders and other associated abnormalities into account. Isolated complete ACC, i.e., agenesis of corpus callosum without other central nervous system anomaly, is rare. A total of six patients, aged nine months to 15 years, with isolated complete ACC diagnosed by brain image study in the past eight years of our hospital were evaluated for associated defects and prognosis. Isolated complete ACC without associated congenital heart disease (CHD) was found in four of the six patients (4/6), of whom three had normal development so far. The other two patients (2/6) were found to have associated CHD and both had poor prognosis. This result suggests that checking for any associated CHD may play an important prognostic role for isolated complete ACC patients. Therefore, it is recommendable that prenatal brain MRI and fetal echocardiography should be performed for evaluation and for genetic consultation whenever ACC is suspected.

Rapid spontaneous closure and remodelling of a medium-sized symptomatic congenital coronary artery fistula in an infant before the age of 3 months

It is controversial to observe or close symptomatic congenital coronary artery fistula in infants. We herein describe a medium-sized symptomatic congenital coronary artery fistula that underwent rapid spontaneous closure in an infant aged <3 months.

Hemopericardium from right atrial laceration in a newborn

We report the case of a newborn who suffered right atrial laceration during delivery. To our knowledge, there has been no previous report of blunt injury causing right atrial laceration with hemopericardium complicated by cardiac tamponade in the perinatal period.

A Comparison of Three Methods of Regulating the Body Temperatures of Healthy Full-term Newborns

Hypothermia is a common problem in neonates, and regulating the body temperatures of newborns is important in a neonatal care facility. Our study was designed to compare three methods of regulating body temperature of healthy full-term babies. All newborns after birth were clothed and rectal temperatures were taken. Healthy babies with rectal temperatures greater than 36.5 ℃ were enrolled in the study. They were divided randomly into three groups: group A wore cotton hats, group B were placed under heat lamps, and group C wore cotton hats and were placed under heat lamps. Axillary temperatures were taken every hour and recorded for 12 hours. There were 30 full-term babies in each group, with a total of 90 healthy babies. After statistical analysis using ANOVA, the basic data, including gestational age, birth body weight, 1(superscript st) and 5(superscript th) Apgar scores and sex, of the infants in these three groups did not show significant differences. The body temperatures of each group showed similar increases during the 12-hour period. No baby had hypothermia during the study. All three methods of regulating newborn temperatures, compared with each other using repeated measurements with Generalized Estimating Equation (GEE), showed similar efficiencies. Therefore, we concluded that the heat lamp was not necessary in the management of the body temperature of healthy full-term babies with initial rectal temperature ＞36.5℃. In addition to the routine care, a cotton hat worn by the newborn was enough to prevent hypothermia.

Subclavian Central Venous Catheterization in Neonates: Experience in a Medical Center

Objectives: Central venous access is an important aspect of medical treatment in the neonatal intensive care unit (NICU). Central venous lines (CVLs) are needed for cardiac catheterization, total parenteral nutrition (TPN), intravenous antibiotics, multiple transfusions, and chemotherapy. The primary aim of this study was to demonstrate that central venous catheterization in neonates could be done through the subclavian vein as an alternative to the femoral vein. Methods: In our NICU, we always try to insert CVLs through the femoral vein first. When multiple attempts fail in the femoral area, we then approach the subclavian vein. Between January 1999 and June 2004, we performed a total of 20 subclavian vein catheterizations (SVC) in 18 neonates who weighed between 2.2 kg and 4.8 kg. Results: We had a success rate of 80% (16/20). Ten of the 16 successful insertions were done in 2 attempts and three sustained arterial punctures. In the 4 failed insertions, 1 patient had a pneumohemothorax and 3 had arterial punctures. Conclusions: In our NICU, we need intact femoral veins for cardiac catheterization. Excessive femoral vein catheterizations (FVC), however; often result in thrombosis, stricture, and hematoma which complicate subsequent FVC attempts. In this study we found subclavian venous catheterization in neonates could be used as an alternative procedure.