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[Ultrasound-guided central venous cannulation in neuropaediatric patients to avoid measures causing potential
H Trautner1, C-A Greim, H Arzet
1Klinik für Anaesthesiologie, Universitätsklinikum Würzburg,Würzburg. htrautner@gmx.de
Insights
Ultrasound-guided internal jugular vein (IJV) cannulation in children is safe and effective without Trendelenburg positioning or PEEP. This method simplifies central venous access in pediatric patients, improving procedural success rates.
Area of Science:
- Pediatric Anesthesiology
- Vascular Access Procedures
- Ultrasound Guidance
Background:
- Traditional methods like Trendelenburg position or increased intrathoracic pressure aid internal jugular vein (IJV) cannulation in children.
- These maneuvers are contraindicated in pediatric patients with elevated intracranial pressure.
- Ultrasound guidance offers a potential alternative for IJV cannulation in neuro-pediatric patients.
Purpose of the Study:
- To evaluate the efficacy and safety of ultrasound-guided internal jugular vein (IJV) cannulation in anesthetized and ventilated pediatric patients.
- To determine if ultrasound guidance can replace traditional maneuvers like Trendelenburg position or PEEP for IJV access.
Main Methods:
- Prospective study involving 120 pediatric patients (newborns, infants, and small children).
- Sonographic measurement of the right IJV cross-sectional area in horizontal and Trendelenburg positions with varying levels of PEEP.
- Ultrasound-guided IJV puncture performed under predetermined position and PEEP conditions.
Main Results:
- The IJV cross-sectional area increased by 24% with Trendelenburg and 63% with Trendelenburg and PEEP 10 cm H2O.
- Ultrasound-guided puncture achieved a 98% success rate on the first attempt, with only two patients requiring a second attempt.
- Cannulation was successful regardless of patient positioning and PEEP levels.
Conclusions:
- Ultrasound-guided visualization of the IJV allows for easy and safe central venous cannulation in newborns, infants, and small children.
- Measures such as Trendelenburg position or PEEP are unnecessary for successful IJV puncture when using ultrasound guidance.
- This technique enhances safety and efficiency of central venous access in pediatric patients.
Background:
Certain measures such as the Trendelenburg position or an increase in intrathoracic pressure raise the chances for a successful puncture of the internal jugular vein (IJV) particularly in paediatric patients. However, these measures are contraindicated in patients with increased intracranial pressure. Therefore, in anaesthetised and ventilated neuropaediatric patients we investigated whether ultrasound-guided cannulation of the IJV can replace these measures.
Methods:
In this prospective study,8 newborns, 46 infants and 66 small children were included. The cross-sectional area of the right IJV was sonographically measured in horizontal and 15 degrees Trendelenburg positions with or without PEEP 0, 5 or 10 cm H(2)O. The IJV was then punctured at the conditions of a predetermined position and PEEP combination under sonographic guidance (5-8 MHz).
Results:
The mean cross-sectional area of the IJV was 0.3-1.6 cm(2) in the horizontal position without PEEP ( n=120) and was enlarged due to the Trendelenburg position by 24% and by 63%, when PEEP 10 cm H(2)O was added. Independent of positioning and PEEP the ultrasound-guided puncture was successful at the first attempt in 98% of cases and a second attempt had to be made in only two children.
Conclusions:
Under sonographic visualisation of the cross-sectional area, the IJV can easily and safely be punctured for central venous cannulation in newborn, infants and small children without measures such as the Trendelenburg position or implementation of PEEP.
