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Venous patency after open central-venous cannulation
I E Willetts1, M Ayodeji, W H Ramsden
1Department of Paediatric Surgery, United Leeds Teaching Hospitals NHS Trust, UK.
Insights
Doppler ultrasound scans can assess internal jugular vein (IJV) patency after central venous catheter (CVC) placement in children. While valuable, USS findings require cautious interpretation, as collateral veins can mimic patency, impacting successful recannulation rates.
Area of Science:
- Pediatric Surgery
- Vascular Imaging
- Interventional Radiology
Background:
- Central venous cannulation (CVC) is common in pediatric care.
- Re-cannulation of internal jugular veins (IJVs) is often necessary.
- Assessing IJV patency prior to re-cannulation is crucial.
Purpose of the Study:
- To evaluate the diagnostic accuracy of Doppler ultrasound (USS) for assessing IJV patency.
- To determine the reliability of USS in children needing repeat CVC.
- To assess the success rate of re-cannulating previously accessed IJVs.
Main Methods:
- Prospective study of 66 children undergoing repeat CVC.
- Doppler USS performed prior to surgical exploration.
- Surgical exploration to confirm USS findings of IJV patency.
- Analysis of USS findings (patent, stenosed, obliterated) versus surgical outcomes.
Main Results:
- Doppler USS indicated patency in 88.6% of IJVs.
- Surgical exploration confirmed patency in 89.4% of "USS patent" veins.
- Seven cases (10.6%) of "USS patent" veins were found obliterated during surgery, often due to collateral vessels.
- Overall successful recannulation rate was 74.6% for previously accessed IJVs.
Conclusions:
- Doppler USS is a valuable, though not perfectly reliable, tool for assessing IJV patency in children requiring repeat CVC.
- USS findings should be interpreted cautiously, considering the potential for collateral vessel formation.
- Approximately three-fourths of previously cannulated IJVs remain patent and suitable for re-cannulation.
Abstract:
To investigate the value of Doppler ultrasound scan (USS) assessment of internal jugular vein (IJV) patency after previous open central-venous cannulation (CVC), a prospective study of 66 consecutive children (median age 4.5 years; range 4 months-17 years) who had previously undergone open insertion of at least one indwelling IJV line and required further CVC for completion of therapy was undertaken. All underwent Doppler USS examination prior to surgery. Where patency of the previously cannulated vein was suggested ultrasonographically, the accuracy of this finding was confined at open surgical exploration. Initial CVCs were in situ for a median of 9 months (1 month-4 years) prior to removal. The median interval to repeated CVC was 11 months (3 weeks-45 months). In 79 Doppler USS, 70 (88.6%) veins appeared patent, 3 (4.2%) stenosed, and 6 (7.6%) obliterated. Of the 70 "USS patent" veins, 66 were explored. Patency was confirmed surgically in 59 (89.4%) and a new CVC successfully inserted. Seven (10.6%) apparently patent veins on USS were found to be obliterated at open exploration. Review of USS images in these cases suggested that enlarged collateral veins were usually responsible. Overall, successful recannulation was possible in 74.6% of all previously accessed veins. In children requiring repeated CVC, Doppler USS of neck veins is a valuable but not entirely reliable guide to the presence of underlying vessel patency and should be interpreted with caution. At least three-fourths of previously cannulated IJVs remain patent after catheter removal and can be reused for CVC.