Prospective analysis of percutaneous central venous catheterization in infants <4.0 kg undergoing cardiac surgery

Our previous study showed that the success rate of cannulation of the internal jugular vein (IJV) was significantly decreased in infants weighing less than 4.0 kg. We prospectively evaluated results of central venous catheterization in 101 infants weighing less than 4.0 kg undergoing cardiac surgery. The first attempt was routinely performed on the right IJV. If the first attempt failed, the anesthesiologist was free to choose the cannulation site. We examined the effects of patient weight and the experience of the anesthesiologist on successful central catheterization and efficacy of the external jugular vein (EJV) if the first attempt failed. The first right IJV cannulation was successful in 53 infants (52.5%) and the overall successful catheterization rate was 82.2%. Success rates of cannulation of the right IJV, left IJV, and EJV were 64, 13, and 6%, respectively. Body weight contributed significantly to successful catheterization, but the experience of the anesthesiologist did not. These results suggest that EJV cannulation improves the successful central catheterization in infants weighing less than 4.0 kg if IJV cannulation fails. Body weight of an infant, but not the experience of the anesthesiologist, contributed to successful catheterization in this patient population.