Table of Contents

HK J Paediatr (New Series)
Vol 2. No. 2, 1997

HK J Paediatr (New Series) 1997;2:178

Proceedings of Scientific Meeting

Role of Echocardiography in the Management of Patients Requiring Central Venous Catheterization

KC Chan, CW Luk, D Wong, KS Lun, SH Lee, YM Ng

HK J Paediatr (new series) 1997;2:175-186

Hong Kong Paediatric Society 35th Anniversary Scientific Meeting September 6,1997

Introduction: Central venous catheterization (CVC) facilitates the care of patients requiring long term parenteral treatment. Complications arised after their prolonged use as well as conditions precluding their initial implantation have been described. We reported here our experience in the use of echocardiography (echo) in these group of patients.

Method and Results: From the two rears period starting 1st July 95 to 30th June 97, 8 patients ( M:F = 2:6 ) were referred for a total of 18 echo assessments. Their hospital notes were reviewed. Echo assessment was transthoracic (TTE) = 13, transesophageal (TEE) = 5. Patients mean age at TTE = 60 months (in), range: 7 m -121 m . Mean age at TEE = 102.2 m, range: 39m -122 m. Main indications for CVC and patients diagnosis are: (a) chemotherapy = 4, acute Iymphoblastic leukaemia (1), hepatoblastoma (3); (b) parenteral nutrition = 4, hypogangliosis (1), post massive gut resection (3). The 13 TTE including 2 follow up assessments were performed in 11 different clinical events: pre-implantation assessment (1), fever or suspected sepsis (2), documented bacteraemia (3), blocked catheter (1), abnormal catheter position on X ray (2), acute neurological symptoms after catheter flushing (2) . Abnormal TTE was found in 7 (7 / 11 = 64%): thrombi in 3, abnormal catheter position in 3, venous thrombosis in 2. Inadequate acoustic window was present in 1. Of the 5 TEE, 2 were performed electively for history of CVC infection; they were normal. One performed after thrombi shown on TTE showed additional thrombi, 2 were intra-operative TEE serving as guide to optimal catheter positioning.

Outcome: Clinical management were altered after echo in 7 episodes: catheter removal 1, heparin infusion then removal 1, thrombolytics use then removal 1, catheter repositioning 2, venograms arranged and later confirmed venous thrombosis 2. One of these two required CVC in other site.

Conclusion: Echo is an invaluable tool in the preimplantation assessment, catheter position guidance and thrombi detection in these group of patients. TTE and TEE are complimentary. Management alterations may be required upon findings of abnormal results.


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