Subclavian central venous catheterization in critically ill children in Türkiye: a safe and feasible approach in a single-center experience.

BACKGROUND: Central venous catheter (CVC) insertion is essential procedure in the management of critically ill pediatric patients. However, the optimal catheter insertion site remains controversial due to varying complication rates. This study aimed to evaluate the feasibility and safety of subclavian vein (SCV) catheterization compared to femoral vein (FV) and internal jugular vein (IJV) access in a pediatric intensive care setting. METHODS: This retrospective study included all patients admitted to the pediatric intensive care unit (PICU) of a tertiary hospital over a 1-year period (March 2022-March 2023) who underwent nontunneled CVC placement. RESULTS: Among 174 patients included (median age 29 months, 60.3% male), 52.9% had SCV, 23.6% FV, and 23.6% IJV catheterization. The overall CVC success rate was 99.4%. There was no statistically significant difference in mechanical complications, catheter-related bloodstream infections, or thrombosis between groups; however, thrombosis occurred most frequently in the FV group (12.2%). The median age in the SCV group was significantly lower than in the other groups (20 months; interquartile range, 10-63; P<0.001), while the presence of chronic diseases was significantly higher in this group (P=0.002). In multivariate logistic regression, catheter site was identified as the only independent predictor of thrombosis, with FV catheterization associated with increased risk (odds ratio, 2.75; P=0.016). CONCLUSIONS: SCV catheterization appears to be a feasible and safe option for critically ill children, even in younger patients and in the presence of chronic comorbidities. Despite potential technical challenges, SCV access represents a viable alternative to IJV and may offer potential advantages over FV, particularly with regard to thrombosis risk.