WOFAPS 2025 8th World Congress of Pediatric Surgery

Wefag Ahmed, Farah Roslan, Fiona Dickinson, Khalid ElMalik

University Hospitals of Leicester

Purpose

Central venous access (CVA) under fluoroscopic guidance is a common paediatric procedure. However, radiation exposure remains a concern, particularly in children who may undergo multiple interventions. This study aimed to evaluate the level of ionising radiation exposure during CVA insertion and compare it with published data to assess safety and optimisation.

Method

A retrospective review was conducted for all paediatric patients who underwent fluoroscopic-guided CVA insertion between April 2021 and April 2024. Data collected included patient age and weight, type of catheter, insertion technique, clinical indication, fluoroscopy time, dose area product (DAP), and estimated effective dose.

Results

A total of 254 catheters were inserted; 97.3% (247) were placed percutaneously with ultrasound guidance, while 2.7% (7) were inserted via an open technique. The primary indications included haemato-oncology (102), parenteral nutrition (74), and prolonged intravenous antibiotic therapy (74). Catheter types included 131 tunnelled lines, 58 implanted ports, and 64 peripherally inserted central catheters (PICCs). The mean patient age was 6.7 years (SD ±5.3), and mean weight was 25.9 kg (SD ±11.1). The median fluoroscopy time was 7 seconds (range: 1–306), median DAP was 0.0195 Gy·cm² (range: 0.00008–1.14), and median effective dose was 0.116 mGy (range: 0.00051–7.16). Compared to previously reported median DAP values (0.0352–0.28 Gy·cm²), our results demonstrate a significantly lower exposure.

Conclusion

Radiation exposure during CVA insertion in this cohort was low, falling below most values reported in the literature. These findings underscore the effectiveness of optimised techniques and reduced screening times in minimising radiation risks in paediatric patients.