Jugular venous bulb catheterization in infants and children

Area of Science:

• Pediatric Neurology
• Neurocritical Care
• Cerebrovascular Physiology

Background:

• Cross-brain oxygen extraction is linked to neurological recovery in brain-injured adults and children.
• Measuring cerebral oxygen extraction is not standard pediatric clinical practice due to lack of data on jugular venous bulb (JVB) catheterization safety and complications in children.
• Previous studies have not established the feasibility of JVB catheterization in pediatric populations.

Purpose of the Study:

• To assess the feasibility and safety of jugular venous bulb (JVB) catheterization in deeply comatose neonates and children.
• To measure cross-brain oxygen extraction in pediatric patients with severe brain injury.
• To evaluate the relationship between JVB catheterization and functional neurologic recovery.

Main Methods:

• Jugular venous bulb (JVB) catheterization was performed in 26 comatose children (neonates to 14 years old) using the Seldinger technique or venous cutdown.
• Cerebral venous oxygen content was measured, and cross-brain oxygen extraction was calculated.
• Intracranial pressure (ICP) and arterial pressure were continuously monitored throughout the procedure.

Main Results:

• JVB catheterization was successful in 25 out of 26 children, demonstrating the technique's feasibility.
• Minor complications included inadvertent carotid artery puncture (4 children) and catheter malposition (2 children).
• ICP was not significantly affected by the cannulation procedure, and catheters remained functional for an average of 3 days.

Conclusions:

• Jugular venous bulb (JVB) catheterization is a feasible bedside technique for measuring cross-brain oxygen extraction in deeply comatose children.
• The procedure appears safe with minimal impact on intracranial pressure in this pediatric cohort.
• This method holds promise for monitoring and potentially predicting neurological recovery in pediatric brain injury.