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Comparison of two approaches to internal jugular vein cannulation in young children: ultrasonographic evaluation
1Department of Radiology, Soonchunhyang University College of Medicine, Bucheon, Korea.
Insights
The low approach offers a larger cross-sectional area for internal jugular vein cannulation in children. Clinicians should consider this optimal site while being aware of potential carotid artery overlap and anatomical variations.
Area of Science:
- Pediatric vascular anatomy
- Ultrasound imaging in children
- Vascular access procedures
Background:
- Percutaneous internal jugular vein cannulation is challenging in pediatric patients due to small vessel size and anatomical variability.
- Identifying optimal cannulation sites is crucial for successful and safe venous access in children.
Purpose of the Study:
- To compare the cross-sectional area of the right internal jugular vein (IJV) at two different anatomical levels in children.
- To evaluate the relative anatomy of the IJV with respect to the carotid artery (CA) at these two levels.
- To determine the ideal site for internal jugular vein cannulation in young children.
Main Methods:
- Ultrasound assessment of 47 children to measure IJV cross-sectional area and CA overlap.
- Evaluation at two distinct levels: high (cricoid cartilage) and low (sternocleidomastoid muscle junction).
Main Results:
- The low approach demonstrated a significantly larger IJV cross-sectional area (28.8% increase, P < 0.01).
- Significant carotid artery overlap with the IJV was observed in both approaches (low: 48.9% partial, 42.6% complete; high: 44.7% partial, 34.0% complete).
- Carotid artery overlap was significantly higher in the low approach compared to the high approach (P < 0.02).
Conclusions:
- The low approach is optimal for internal jugular vein cannulation due to its larger vessel size.
- Despite increased CA overlap in the low approach, IJV covers the CA in most patients in both sites.
- Awareness of significant anatomical variations is essential for clinicians performing IJV cannulation in children.
Background:
Percutaneous cannulation of internal jugular vein is difficult in pediatric patients because of its small size and anatomic variation. The aim of this study is to investigate cross-sectional area and relative anatomy of right internal jugular vein with respect to the carotid artery in two approaches and thereby to find ideal cannulation site in young children.
Methods:
The cross-sectional area of right internal jugular vein and the degree of the carotid artery overlap was evaluated in 47 children using ultrasound at two levels; 1) at the cricoid cartilage (high approach) and 2) at the junction of the two heads of the sternocleidomastoid muscle (low approach).
Results:
The cross-sectional area was significantly larger by about 28.8% in the low approach than that of the high approach (P < 0.01). The internal jugular vein was partially overlapping the carotid artery in 48.9% and completely overlapping in 42.6% in the low approach and in 44.7% and 34.0% in the high approach respectively. The carotid artery overlap was significantly higher in the low approach when compared with the high approach (P < 0.02).
Conclusions:
In terms of cross-sectional area, the low approach with larger size is optimal for internal jugular vein cannulation. Although the degree of the carotid artery overlap was higher at the low approach, the internal jugular vein was partially or completely covering the carotid artery in most patients in both approaches. When attempting to cannulate the internal jugular vein, clinicians should be aware of the large anatomic variations.
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