Alireza Mahdavi - Anesthesiologist, Anesthesiology Research Center (ARC), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran.
Ashkan Panah - Anesthesiologist, Shiraz University of Medical Sciences, Shiraz, Iran.
Afsaneh Sadeghi Sadeghi - Anesthesiologist, Anesthesiology Research Center (ARC), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran.

Background Central venous catheter (CVC) is used for measuring hemodynamic variables, transfusion of blood, fluids and medications when peripheral vascular lack sufficiency. Unfortunately CVC is associated with many complications ranging from anxiety and discomfort for the patient to severe mechanical side effects such as arterial lacerations, pleural and pericardial injury as well as infection and thrombosis. This study aimed to survey of a practical approach to central venous catheterization in pediatric patients. Materials and Methods In this retrospective and descriptive study, rate of success and complications of central venous catheterization by the anesthesia team for the hospitalized children 0-15 years from 2009 to 2016 years at Mofid Children Hospital, Tehran-Iran, were investigated.  Advancement of catheters tips in pleural space; peritoneal cavity and pericardium were recognized by rat tail blood flow as a practical approach which was proved by chest X- ray.  Successful rate and complications of inserting CVC were collected by researchers using medical records of the patients.  Results There were 2,385 (53%) female and 2,115 (47%) male patients. Patient’s age ranged from 1 month to 10 years, mean 12.25±6.45 months. About 4,500 patients who underwent central venous catheterization were investigated that 815 patients (18%) had improper catheterization in the internal jugular and 374 patients (8%) had accidental arterial injury and 160 patients (3%) had accidental pleural injury. Accidental pleural injury were recognized by rat tail blood flow in the liquid column connected to the catheter to the patient s bedside and all of them was proven by taking control image. Conclusion Using rat tail blood flow as a practical approach to central venous catheterization in pediatric patients can be associated with prevention of the plural injury and subsequent pneumothorax and hemothorax.

Central Venous Catheters, Pediatrics, Pneumothorax