Response to the Letter to the Editor: Central Venous Catheter in Pediatric Intensive Care: Anatomical Landmark or Ultrasound Guide?

Central Venous Catheter in Pediatric Intensive Care: Anatomical Landmark or Ultrasound Guide?

We thank Rodríguez-Campos, Falcon, and Carreazo for their interest in our article, reporting the practice patterns of central venous catheter (CVC) placement and confirmation in a pediatric critical care in North America, which showed wide practice variation in site selection, use of US guidance for insertion, and confirmation of CVC tip position among pediatric critical care providers.[1] Rodriguez-Campos et al pointed out a greater use of ultrasound (US) guidance among our respondents (90% for internal jugular [IJ] catheters), compared with their data (32%). The IJ was the most commonly cannulated site on their cohort, which is consistent with it being the preferred site among our respondents. They assumed that the data about the efficacy of US to reduce the number of canulation attempts and mechanical complication is ours; although it was discussed at length in our paper, we cited the work of Al Sofyani et al[2] and Lau et al[3] among others.[4] [5] [6] [7] [8] [9] There are multiple studies, in both adult and pediatric patients, which demonstrate that the use of US reduces number of attempts and risk of CVC-related complications, especially for the femoral and IJ sites.[10] [11] There is also growing data on US-guided subclavian CVC placement, with multiple small, single-centered studies in pediatrics demonstrating high success rate, reaching 100%,[6] [7] [8] with shorter procedure duration,[8] lower central line-associated bloodstream infection (CLABSI) rate,[5] and low to no major complications such as arterial puncture or pneumothorax[8] with US-guided subclavian cannulation. The barrier to US use needs to be explored in high-quality prospective studies.

The lack of reduction of cannulation attempts with US use in Rodríguez-Campos et al cohort could be due to the inadequate sample size (n = 113), with only 37 catheters inserted using US guidance, as this data was not ours, and we were mainly interested in reporting the practice patterns of central line insertion and confirmation among pediatric critical care providers. We therefore believe that the question about the discrepancy between their data and the cited data should be directed to the corresponding authors of the cited papers.

Publication History

Received: 05 April 2021

Accepted: 11 August 2021

Article published online:
17 September 2021

• References

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