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Ultrasound evaluation of techniques for internal jugular vein puncture in children

Sérgio Tomaz Schettini1, Luiz Fernando Ybarra Martins de Oliveira, Harold Ruiz Henao

  • 1Division of Pediatric Surgery, Department of Surgery, UNIFESP, Brazil. stschettini@uol.com.br

Acta Cirurgica Brasileira
|September 18, 2008
PubMed

Insights

The best ultrasound-guided approach for right internal jugular vein (RIJV) puncture in children is a lateral approach with the patient in neutral position and Trendelenburg tilt, without a shoulder roll. This method maximizes the RIJV

Area of Science:

  • Pediatric Ultrasound
  • Vascular Access Procedures
  • Anatomical Imaging

Background:

  • Ultrasound-guided central venous access is crucial in pediatric care.
  • Optimizing internal jugular vein visualization is key for safe and effective cannulation.
  • Limited data exists on ideal patient positioning for right internal jugular vein (RIJV) access in children.

Purpose of the Study:

  • To identify the optimal patient position and ultrasound approach for the best transversal section of the RIJV in children.
  • To enhance the safety of RIJV puncture procedures through improved visualization.

Main Methods:

  • Ultrasound evaluation of three RIJV access points (anterior, lateral, posterior) in 57 healthy children.
  • Analysis of various head positions and scapular support (roll) in supine and Trendelenburg (30°) positions.
  • Statistical analysis using variation analysis for intra-individual comparisons.

Main Results:

  • The lateral puncture approach with the patient in neutral position and Trendelenburg tilt (without a shoulder roll) yielded a significantly larger RIJV cross-sectional area (p<0.0001).
  • This specific positioning provided a superior view compared to all other tested configurations.

Conclusions:

  • Lateral puncture in neutral head position with a 30° Trendelenburg tilt and no shoulder roll is the safest and most effective method for RIJV access in children.
  • This technique optimizes RIJV visualization, facilitating safer pediatric central venous catheterization.
Abstract

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