Leyvi G, Taylor DG, Reith E, Wasnick JD: Utility of ultrasound-guided central venous cannulation in pediatric surgical patients: A clinical series
Department of Anesthesiology, Montefiore Medical Center, New York, New York, United States Pediatric Anesthesia
(Impact Factor: 1.85).
12/2005; 15(11):953-8. DOI: 10.1111/j.1460-9592.2005.01609.x
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.
Available from: Mohamed S Kabbani
- "C entral vascular access is a lifesaving procedure in small compromised infants. Landmark-guided insertion is associated with a high failure rate and added complications     . The use of ultrasonography facilitates venous or arterial cannulation. "
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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.
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.
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.
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.
Available from: Sylvain Renolleau
- "The ultrasound-guidance technique is becoming the gold standard for IJV catheterization because it can both increase the success rate and decrease the complications related to central venous catheter placement. Since 2002, the National Institute for Clinical Excellence (NICE) has recommended the use of ultrasound guidance as the preferred method for insertion of a central venous catheter into the IJV in children. "
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ABSTRACT: Percutaneous central venous cannulation (CVC) in infants and children is a challenging procedure, and it is usually achieved with a blinded, external landmark-guided technique. Recent guidelines from the National Institute for Clinical Excellence (NICE) recommend the use of ultrasound guidance for central venous catheterization in children. The purpose of this study was to evaluate this method in a pediatric and neonatal intensive care unit, assessing the number of attempts, access time (skin to vein), incidence of complication, and the ease of use for central venous access in the neonatal age group.
After approval by the local departmental ethical committee, we evaluated an ultrasound-guided method over a period of 6 months in 20 critically ill patients requiring central venous access in a pediatric intensive care unit and a neonatal intensive care unit (median age 9 (0-204) months and weight 9.3 (1.9-60) kg). Cannulation was performed after locating the puncture site with the aid of an ultrasound device (8 MHz transducer, Vividi General Electrics(®) Burroughs, USA) covered by a sterile sheath. Outcome measures included successful insertion rate, number of attempts, access time, and incidence of complications.
Cannulation of the central vein was 100% successful in all patients. The right femoral vein was preferred in 60% of the cases. The vein was entered on the first attempt in 75% of all patients, and the median number of attempts was 1. The median access time (skin to vein) for all patients was 64.5 s. No arterial punctures or hematomas occurred using the ultrasound technique.
In a sample of critically ill patients from a pediatric and neonatal intensive care unit, ultrasound-guided CVC compared with published reports on traditional technique required fewer attempts and less time. It improved the overall success rate, minimized the occurrence of complications during vein cannulation and was easy to apply in neonatal and pediatric patients.
Available from: Norair Airapetian
- "Les voies fémorales et jugulaires internes semblent plus sûres que la voie sous-clavière en terme de taux de complication à la pose. Au niveau jugulaire interne, les travaux récents plaident en faveur de la technique échoguidée par rapport à la méthode reposant sur les repères anatomiques externes : taux d'échec et de complications à la pose moindre   . Chez le petit enfant (poids inférieur à 7,5 kg), la pose échoguidée semble supérieure à la pose classique  : 97 % de succès de pose des CVC jugulaires internes en échographie bidimensionnelle versus 62 % avec les repères anatomiques externes pour des anesthésistes expérimentés . "
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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.
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