Utility of ultrasound-guided central venous cannulation in pediatric surgical patients: a clinical series
ABSTRACT Central venous cannulation can be particularly difficult in pediatric patients. Central line placement is associated with many well-known complications. While ultrasound-guided techniques are well established, the majority of central venous catheters are placed using landmark guidance. This retrospective study compares the safety and efficacy of ultrasound guidance vs landmark guidance in central venous cannulation of pediatric cardiac surgery patients.
The medical records of 149 pediatric patients undergoing cardiac surgery over 3-year period were reviewed. Patients were classified into two cohorts based on whether central venous cannulation of the internal jugular vein was performed by ultrasound or landmark guidance. Overall success and traumatic complication rates were compared between the two groups. Additionally, comparisons between the groups were made to determine if patient size or age affected the success rate of either approach in different manner.
Patients in the ultrasound-guided (n = 47) and the landmark-guided (n = 102) groups were similar with respect to age, weight, and surgical procedure for which central venous access was indicated. The overall success rate for cannulation of the internal jugular vein was 91.5% in the ultrasound-guided group and 72.5% in the landmark-guided group (P = 0.010). But in the subgroup of children under 1 year of age, success rate was 77.8% in ultrasound group and 60.9% in landmark group (P = 0.44); in children under 10 kg in weight, success rate was 80% in ultrasound group and 56.7% in landmark group (P = 0.19). There were no significant differences in the rate of traumatic complications between the two methods.
The overall success of internal jugular vein cannulation for pediatric cardiac surgery is significantly improved with the use of ultrasound guidance, without a significant difference in traumatic complications. However, mostly children above 1 year of age or 10 kg of weight experience advantages of ultrasound technique.
- SourceAvailable from: Mohamed S Kabbani[Show abstract] [Hide abstract]
ABSTRACT: Introduction Safely obtaining vascular access in the pediatric population is challenging. This report highlights our real-world experience in developing a safer approach to obtaining vascular access using ultrasound guidance in children and small infants with congenital heart disease. Methods As part of a quality initiative we prospectively monitored outcomes of all vascular access attempts guided by ultrasound from January 2010 till September 2010. Variables monitored included age, weight, the time from first needle puncture to wire insertion, site of insertion, number of attempts, type of line and complications. Results 77 attempts (15 arterial and 62 venous) to obtain vascular access were made in 43 patients. The mean age was 15 months (6 days – 11 yr, median 2.5 months). The mean weight was 7.2 kg (2 – 46 kg, median 3.8). Success rates were 93% and 95% for arterial and venous cannulation respectively. Mean time from first needle puncture to wire insertion was 3.9 min (0.5-15 min, median 2 min). 55 central line cannulations (75%) were successful from the first puncture, 17(23%) were successful from the second puncture and one case (2%) required 3 punctures. Thirty patients (45%) were less than 3.5kg. This lower body weight did not affect success rate, which was unexpectedly high (96.6%). There were no associated complications. Conclusion Ultrasound guided vascular cannulation in critically ill pediatric patients is safe, effective and efficient. This approach has a high success rate and in our setting was associated with zero complications.Journal of the Saudi Heart Association 10/2014; DOI:10.1016/j.jsha.2014.04.003
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ABSTRACT: The use of central venous catheters (CVC) is common in intensive care. Traditionally, they are inserted by using surface anatomical landmarks. In recent years, two-dimensional imaging ultrasound guidance has become the reference of adult and child internal jugular CVC insertion, and could become the reference for subclavian and femoral veins, as well as, in children little weight. The ultrasound guided puncture should be considered in most clinical circumstances where CVC insertion is necessary. Given these developments, the operator must maintain their ability to use landmark method (for all situations where the equipment is unavailable, emergencies…) and acquired ultrasound-guided technique.Réanimation 12/2008; 17(8). DOI:10.1016/j.reaurg.2008.09.015
- Revista espanola de anestesiologia y reanimacion 01/2008; 55(10). DOI:10.1016/S0034-9356(08)70673-X