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Ultrasound guidance for internal jugular vein cannulation in PICU: a randomised controlled trial

Tiago Henrique de Souza1, Marcelo Barciela Brandão1, Thiago Martins Santos2

  • 1Deparment of Pediatrics, University of Campinas (UNICAMP), Campinas, Brazil.

Archives of Disease in Childhood
|April 6, 2018
PubMed

Insights

Ultrasound guidance significantly improves internal jugular vein cannulation success rates and reduces complications in children, even for inexperienced pediatricians. This method offers a safer and more effective approach for critically ill young patients.

Area of Science:

  • Medical Imaging
  • Pediatric Critical Care
  • Vascular Access

Background:

  • Internal jugular vein cannulation is a common procedure in pediatric intensive care.
  • The anatomical landmark technique is traditionally used but has limitations, especially for inexperienced practitioners.
  • Ultrasound guidance offers real-time visualization, potentially improving procedural outcomes.

Purpose of the Study:

  • To compare the efficacy and safety of ultrasound-guided internal jugular vein cannulation versus the anatomical landmark technique in pediatric patients.
  • To evaluate outcomes such as success rate, number of attempts, and complication occurrence in inexperienced operators.

Main Methods:

  • A randomized controlled trial was conducted involving 80 children (28 days to <14 years) in a pediatric intensive care unit.
  • Participants underwent internal jugular vein cannulation using either real-time ultrasound guidance or the anatomical landmark technique.
  • Key outcome measures included success rate, success on the first and within three attempts, puncture time, number of attempts, and complications.

Main Results:

  • Ultrasound guidance demonstrated a significantly higher success rate (95% vs. 61%, p<0.001) compared to the landmark technique.
  • Success on the first attempt was achieved in 95% of cases with ultrasound guidance versus 34% with landmarks (p<0.001).
  • Fewer attempts, reduced puncture time, and a lower incidence of complications like hematomas and inadvertent arterial punctures were observed with ultrasound guidance.

Conclusions:

  • Ultrasound guidance is advantageous for internal jugular vein cannulation in critically ill children, even when performed by pediatricians with limited experience.
  • The real-time visualization provided by ultrasound enhances procedural success and safety.
  • This technique should be considered for improving vascular access in pediatric critical care settings.
Abstract

Keywords:
central venous catheterizationintensive carejugular veinproceduresultrasonography

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