Comparative outcomes of central venous access via open jugular and ultrasound-guided subclavian approaches in low-weight pediatric patients: a study with secondary outcomes.

backgroundThe necessity of this study stems from the lack of comparative evidence on the outcomes of central venous catheterization via the open internal jugular and ultrasound-guided subclavian approaches in low-weight pediatric patients. Its innovation lies in the simultaneous evaluation of both primary and secondary outcomes of these two techniques in this vulnerable population.

methodsThis prospective randomized clinical trial at Mardani Azar Children's Hospital (winter 2022-2023) included 92 pediatric patients under five kilograms weight, randomly assigned to either open internal jugular or ultrasound-guided subclavian vein catheterization (46 per group). Procedural success and major complications-such as pneumothorax, arterial cannulation, ectopic catheter placement, infection, and thrombosis-were evaluated intraoperatively and during a two-weeks follow-up using imaging and clinical assessment.

resultsThe mean catheter placement time was significantly longer in the jugular group than in the subclavian group (41.19 ± 13.8 vs. 33.15 ± 12.12 min; P = 0.04). No cases of pneumothorax, hemothorax, bleeding, arrhythmia, occlusion, infection, or death occurred in either group. Hematoma developed only in the jugular group (6 vs. 0; P = 0.02), and all cases were associated with a procedure duration greater than 35 min (P = 0.041). In the subclavian group, all failures (n = 4) and upper limb edema (n = 3) occurred exclusively in patients under 2.5 kg, with both outcomes significantly linked to lower body weight (P = 0.03 and P = 0.014, respectively). Other complications showed no significant differences between groups.

conclusionBoth approaches were generally safe, with no major adverse events observed in either group. Ultrasound-guided subclavian access was associated with a shorter procedure time, whereas hematoma occurred only in the jugular group and catheterization failure and upper-limb edema were seen only in low-weight infants in the subclavian group. However, because access site and technique were evaluated together, their independent effects could not be determined. In addition, the findings in infants weighing < 2.5 kg were based on few events and should be considered hypothesis-generating rather than definitive.

trial registrationThis clinical trial was registered in the Iranian Registry of Clinical Trials (IRCT) with the code IRCT20230901059317N1(Registration date: 2024-02-16).