The central venous anatomy in infants.

Area of Science:

• Pediatric Anatomy
• Vascular Surgery
• Medical Imaging

Background:

• Central venous cannulation is a critical procedure in pediatric critical care.
• Understanding infant central venous anatomy is essential for safe access.
• Previous studies have focused less on detailed infant venous topography.

Purpose of the Study:

• To determine the topographic anatomy of central venous structures in infants.
• To compare infant venous anatomy with that of older children.
• To evaluate the suitability of different venous sites for central access in infants.

Main Methods:

• Autopsy examination of 21 infants (<1 year, <6 kg) and 14 older children.
• Detailed analysis of the internal jugular, external jugular, and subclavian venous systems.
• Measurement of vein diameters and angulation of venous junctions.

Main Results:

• No significant difference in venous diameter between infants and older children.
• Infant subclavian veins enter the central system at acute angles, unlike older children.
• Internal and external jugular veins enter centrally in a nearly straight line in infants.

Conclusions:

• Infant jugular veins offer a safer and more reliable route for central venous cannulation.
• The straight trajectory of jugular veins in infants facilitates percutaneous entry.
• Neck veins should be considered for central access in infants, especially in challenging cases or when subclavian attempts fail.