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Ultrasound evaluations of internal jugular vein punction techniques in children: the easiest method to reach the

Luiz Fernando Ybarra1, H Ruiz, M P Silva

  • 1Pediatric Surgery Division, Surgery Department, Federal University of Sao Paulo, São Paulo, Brazil. lfybarra@gmail.com

Pediatric Surgery International
|December 2, 2008
PubMed

Insights

The best ultrasound-guided catheterization of the right internal jugular vein (RIJV) in children is achieved with lateral access in the Trendelenburg position. This method provides the largest RIJV cross-section for safer and more precise pediatric procedures.

Area of Science:

  • Pediatric Medicine
  • Ultrasound Imaging
  • Vascular Access

Background:

  • Ultrasound guidance is crucial for safe central venous catheterization.
  • Optimizing patient positioning is key to improving visualization and access to the right internal jugular vein (RIJV).
  • Limited data exists on the optimal positioning for pediatric RIJV catheterization.

Purpose of the Study:

  • To determine the optimal patient position and access approach for maximizing the transverse section of the RIJV during ultrasound-guided catheterization in children.
  • To enhance the safety and precision of RIJV access in pediatric patients.

Main Methods:

  • Evaluated three access routes (anterior, lateral, posterior) in 57 healthy children.
  • Assessed ultrasound images in various positions: dorsal decubitus (neutral head, head rotated), with/without pillow, and Trendelenburg position.
  • Utilized analysis of variance to correlate positions with RIJV cross-sectional area.

Main Results:

  • The lateral approach with the patient in the Trendelenburg position yielded a significantly larger transverse section of the RIJV compared to all other tested positions (P<0.0001).
  • This specific positioning maximized the target vessel's visibility and accessibility.

Conclusions:

  • Trendelenburg position with lateral access, without a pillow, is the recommended method for safer and more precise ultrasound-guided RIJV catheterization in pediatric patients.
  • This technique improves the likelihood of successful and safe vascular access in children.

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