Comparative Outcomes of Central Venous Access via Open Jugular and Ultrasound-Guided Subclavian Approaches in Low-Weight Pediatric Patients: A Study with Secondary Outcomes

Background The 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. Methods This 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. Results The 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 minutes; P = 0.04). No cases of pneumothorax, hemothorax, bleeding, arrhythmia, occlusion, infection, or death occurred in either group (P = 1). 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 minutes (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. Conclusion Based on the findings from this study comparing two central venous catheterization techniques in children < 5 kg, both methods were safe when performed by experienced teams, though complications occurred in each. For patients > 2.5 kg, the ultrasound-guided subclavian approach is recommended due to its shorter procedure time and lower hematoma rate. Vein selection should depend on individual anatomy; if ultrasound-guided access fails or neck deformity limits jugular use, the subclavian route under ultrasound guidance is preferred. This procedure, however, requires skill and experience to prevent complications. Trial registration: This clinical trial was registered in the Iranian Registry of Clinical Trials (IRCT) with the code IRCT20230901059317N1(Registration date: 2024-02-16)