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Ultrasound guided internal jugular vein access in children and infant: a meta-analysis of published studies

Stephanie Sigaut1, Alia Skhiri, Ida Stany

  • 1Robert Debre University Hospital, Paris, France.

Paediatric Anaesthesia
|October 30, 2009
PubMed

Insights

Ultrasound prelocation and/or guidance (UPG) did not improve internal jugular vein (IJV) access success rates or reduce complications in children. Further research is needed to clarify its role, especially with novice operators.

Area of Science:

  • Pediatric Anesthesiology
  • Vascular Access Procedures
  • Medical Ultrasound Applications

Background:

  • Central venous catheter placement in children, particularly infants, presents significant technical challenges.
  • Ultrasound prelocation and/or guidance (UPG) is proposed to enhance internal jugular vein (IJV) access, aiming to reduce failure rates and procedural complications.
  • This study systematically reviews the benefits of UPG compared to traditional anatomical landmark (AL) techniques for IJV access in pediatric patients.

Purpose of the Study:

  • To systematically evaluate the advantages of ultrasound prelocation and/or guidance (UPG) over anatomical landmarks (AL) for internal jugular vein (IJV) access in pediatric and infant populations.
  • To synthesize evidence from clinical trials comparing UPG and AL techniques in children.
  • To assess the impact of UPG on success rates, complication rates, and procedure time.

Main Methods:

  • A comprehensive literature search identified clinical trials comparing UPG and AL for IJV access in children and infants.
  • Two independent reviewers assessed study eligibility and extracted data.
  • Meta-analysis techniques, including pooled odds ratios and mean differences with 95% confidence intervals, were employed to combine data.
  • I-squared statistics assessed heterogeneity, guiding the use of fixed or random effects models. Subgroup analyses explored technique variations and operator experience.

Main Results:

  • The meta-analysis included five studies, primarily involving pediatric cardiac surgery patients.
  • UPG showed no significant effect on IJV access failure rate (OR = 0.28 [0.05, 1.47]) or carotid artery puncture rate (OR = 0.32 [0.06, 1.62]) compared to AL.
  • No significant differences were observed in the occurrence of hematoma, hemothorax, or pneumothorax (OR = 0.40 [0.14, 1.13]).
  • Subgroup analysis indicated potential efficacy of ultrasound when used by novice operators or during intraoperative procedures.

Conclusions:

  • This meta-analysis did not find evidence supporting the utility of ultrasound for increasing success rates or decreasing complications during internal jugular vein access in children and infants.
  • The findings suggest that current evidence does not robustly support the routine use of UPG over AL in this population.
  • Further investigation may be warranted to define specific scenarios, such as operator experience levels, where ultrasound may offer benefits.
Abstract

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