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Published on: December 23, 2014
Ultrasound-guided subclavian vein cannulation in infants: supraclavicular approach
Ossam Rhondali1, Rachid Attof, Sylvie Combet
1Department of Anesthesiology, Hôpital mère enfant, 69500 Bron, France.
Insights
This study introduces a new ultrasound-guided supraclavicular approach for subclavian vein (SCV) catheterization in infants. This technique offers a safe and effective method for central venous access, avoiding complications like pinch-off syndrome.
Area of Science:
- Pediatric Medicine
- Medical Imaging
- Vascular Access
Background:
- Internal jugular vein catheterization in infants presents anatomical challenges.
- Subclavian vein (SCV) catheterization via a supraclavicular approach is preferred for long-term central venous access in children.
- The 'pinch-off' syndrome, a risk with SCV catheterization, can be avoided with a supraclavicular approach.
Purpose of the Study:
- To describe a novel ultrasound-guided supraclavicular approach for subclavian vein (SCV) cannulation in infants.
- To evaluate the safety and efficacy of this new technique for central venous catheterization in neonates and small children.
Main Methods:
- Utilized ultrasound (US) guidance for a longitudinal view of the SCV at the supraclavicular level.
- Employed an in-plane puncture technique for direct ultrasonic control during SCV cannulation.
- Reported on 37 US-guided SCV cannulations in infants weighing less than 10 kg.
Main Results:
- The study included 42 infants, with 5 excluded due to poor SCV visualization.
- Procedure duration was under 5 minutes in all but one case.
- Achieved an 81% success rate on the first attempt, and 100% after two attempts, with no major complications.
Conclusions:
- The US-guided supraclavicular SCV puncture is a viable new option for central venous catheterization in infants.
- This technique provides the benefits of SCV cannulation while mitigating the risk of 'pinch-off' syndrome.
- The method is deemed valuable for pediatric patients and relatively easy for physicians trained in US-guided procedures.
Background:
Ultrasound (US) guidance techniques are reported to be safe for internal jugular vein catheterization, although anatomic conditions are not favorable for this approach in infants. The subclavian vein (SCV) seems to be a better site for long-term central venous catheterization in children, with a supraclavicular approach to avoid compression of the central venous catheter between the clavicle and the first rib ('pinch-off' syndrome). We describe a new US-guided approach for supraclavicular SCV cannulation in infants.
Methods:
The principle of this technique is to place the US probe at the supraclavicular level to obtain a longitudinal view of the SCV, and to gain access to the vein with a total ultrasonic control (in-plane puncture) via a supraclavicular approach known since 1965, but rarely used in blind puncture. The results of 37 US-guided SCV cannulations in infants weighing <10 kg are reported.
Results:
Forty-two infants were enrolled in this observational study, and five infants with bad visualization of SCV were excluded. The procedure duration was <5 min in all cases except one. The success rate at the first attempt was 81% and 100% after two attempts. No major complications were reported.
Conclusions:
This US-guided supraclavicular approach for SCV puncture is a new possibility for central venous catheterization in small infants, offering all the advantages of SCV cannulation without the risk of 'pinch-off' syndrome. This technique seems valuable for children and infants and quite easy to apply for physicians trained to US guidance punctures.
