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Percutaneous cannulation of the internal jugular vein in infants and children
Insights
Percutaneous internal jugular vein catheterization in pediatric patients is a serious procedure. Careful technique and proper indication are crucial to minimize life-threatening complications and catheter sepsis.
Area of Science:
- Pediatric Surgery
- Vascular Access
- Critical Care Medicine
Background:
- Percutaneous catheterization of the internal jugular vein is a common procedure in infants and children.
- The technique has been refined over time to improve safety and efficacy.
- Early complications and infection risks necessitate careful management.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous internal jugular vein catheterization in pediatric patients.
- To identify early and late complications associated with the procedure.
- To establish guidelines for optimal patient selection and procedural technique.
Main Methods:
- A retrospective review of 206 pediatric patients undergoing internal jugular vein catheterization since January 1975.
- Analysis of patient demographics, procedural success rates, and complication data.
- Categorization of complications into early (procedural) and late (infection-related).
Main Results:
- Successful cannulation was achieved in 201 out of 206 patients (97.6%).
- An average of 1.8 needle insertions were required per procedure.
- Sixteen early complications occurred, with seven being life-threatening. One death was directly related to catheter insertion.
- Twenty-two late complications were infection-related, including one death from catheter sepsis.
Conclusions:
- Percutaneous internal jugular vein catheterization in infants and children is associated with significant risks.
- A high degree of training and careful patient selection are essential.
- Establishing a maximum seven-day indwelling catheter limit can help minimize septic complications.
Abstract:
A technique for percutaneous catheterization of the internal jugular vein in infants and children was used since January 1975 in 206 patients ranging in age from a few hours to 12 years old. The series included 31 premature infants weighing less than 2,500 grams and 107 babies weighing less than 4,000 grams. Five attempts at cannulation failed. Each catheterization procedure required an average of 1.8 needle insertions before the vein was entered. In 129 patients, the first attempt was successful. Sixteen complications related to the procedure occurred early in our experience, seven of which were life threatening. One death was directly ascribed to the actual insertion of the catheter and mediastinal extravasation of infusion material. Most of the early complications probably could have been injected through the catheter immediately after cannulation, in addition to aspirating the blood and lowering the infusion bottle. The 22 late complications were related to infection; one infant died because of catheter sepsis. To minimize septic complications, an arbitrary limit of seven days was set, after which the catheter was replaced. Cannulation of the internal jugular vein in infants and children should be regarded as a serious surgical procedure to be performed by a trained team and only when properly indicated.