Top

Intensive Care Medicine

Published in:

01-11-2008 | Pediatric Original

Safety and efficacy of ultrasound assistance during internal jugular vein cannulation in neurosurgical infants

Authors: M. Lamperti, D. Caldiroli, P. Cortellazzi, D. Vailati, A. Pedicelli, F. Tosi, M. Piastra, D. Pietrini

Published in: Intensive Care Medicine | Issue 11/2008

Abstract

Objective

Ultrasound guidance (USG) for internal jugular cannulation is the best solution in difficult settings where paediatric patients are involved. This is an outcome study on efficacy and complications of the USG for the internal jugular vein (IJV) cannulation in neurosurgical infants as well as an ultrasound study of anatomical findings of the IJVs in infants.

Design and settings

A prospective study conducted in two Academic Neurosurgical hospitals.

Participants

In 191 babies (body weight <15 kg), anatomical findings were studied. We performed CVC echo guided placement in 135/191 infants (weighting <10 kg).

Results

After a brief training period, both institutions adopted a common protocol and USG device. We obtained successful cannulation in all patients. Carotid puncture (1.5%) was the only main complication registered and minor complications were poor. Time required for cannulation was 12.5 ± 5.7 min. Anatomical findings (in 191 patients) were IJV laterality in 34.6% cases, IJV antero-lateral in 59.7% and anterior in 5.7%. A linear relation was found between weight and internal jugular vein diameter even if R ² = 0.43 and the model cannot be used to predict the exact size of the vein. In 62/135 babies weighting <10 kg, anatomical measurements were done in supine and Trendelemburg position. Trendelemburg position increases significantly (P < 0.001) IJV diameter, but not IJV depth.

Conclusions

We considered ultrasound guidance as the first choice in infants because it can enhance IJV cannulation success, safety, and allows one to measure relationships and diameter of the IJV and optimise the central line positioning.

de Jonge RCJ, Polderman KH, Reinoud JBJ, Gemke RJ (2005) Central venous catheter use in the pediatric patient: mechanical and infectious complications. Pediatr Crit Care Med 6:329–339PubMedCrossRef

Collier PE, Goodman GB (1995) Cardiac tamponade caused by central venous catheter perforation of the hearth: a preventable complication. J Am Coll Surg 181:459–463PubMed

Stocchetti N, Longhi L, Valeriani V (2003) Bilateral cannulation of internal jugular veins may worsen intracranial hypertension. Anesthesiology 99:1017–1018PubMedCrossRef

Schummer W, Schummer C (2004) Patient positioning and ultrasound guidance are important in bilateral cannulation of internal jugular veins. Anesthesiology 100:1624–1625PubMedCrossRef

National Institute for Clinical Excellence (2002) Guidance on the use of ultrasound locating devices for placing central venous catheters. Technology Appraisal Guidance No. 49

Ultrasound guidance of central vein catheterization (2001) Making health care safer: a critical analysis of patient safety practices. In: Rothschild JM (ed) Evidence Report/Technology Assessment, No. 43. Agency for Healthcare Research and Quality, Publication No. 01-E058, Rockville, MD, pp 245–253

Verghese ST, McGill WA, Patel RI, Sell JE, Midgley FM, Ruttimann UE (1999) Ultrasound-guided internal jugular venous cannulation in infants: a prospective comparison with the traditional palpation method. Anesthesiology 91:71–77PubMedCrossRef

Domino K, Bowdle A, Posner K, Spitellie P, Lee L, Cheeney F (2004) Injuries and liability related to central vascular catheters. A closed claims analysis. Anesthesiology 100:1411–1418PubMedCrossRef

Cobb L, Vinocur C, Wagner C, Weintraub W (1987) The central venous anatomy in infants. Surg Gynecol Obstet 165:230–234PubMed

10.

Steinberg C, Weinstock D, Gold J, Notterman D (1992) Measurements of central blood vessels in infants and children: normal values. Cathet Cardiovasc Diagn 27:197–201PubMedCrossRef

11.

Alderson PJ, Burrows FA, Stemp LI, Holtby HM (1993) Use of ultrasound to evaluate internal jugular vein anatomy and to facilitate central venous cannulation in paediatric patients. BJA 70:145–148PubMedCrossRef

12.

Taug AG, Neumayr P, Cahalan MK et al. (1993) Anatomic relationship of the right carotid artery and internal jugular vein in paediatric patients with congenital heart disease. In: 15th Ann Meeting Soc Cardiovasc Anesthesiol, pp 269

13.

Mallinson C, Bennet J, Hodgson P, Petros AJ (1999) Position of the internal jugular vein in children. A study of the anatomy using ultrasonography. Paediatr Anaesth 19:111–114

14.

Maecken T, Grau T (2007) Ultrasound imaging in vascular access. Crit Care Med 35:178–185CrossRef

15.

Leyvi G, Taylor D, Reith E, Wasnick J (2005) Utility of ultrasound-guided central venous cannulation in pediatric surgical patients: a clinical series. Paediatr Anaesth 15:953–958PubMedCrossRef

16.

Agoustides JG, Diaz D, Weiner J (2002) Current practice of internal jugular vein cannulation in a university anesthesia department: influence of operator experience on success of cannulation and arterial injury. J Cardiothorac Vasc Anesth 16:567–571CrossRef

17.

Goss CM (1973) The veins. In: Gray’s anatomy. Lea & Febiger, Philadelphia, pp 697–698

18.

English ICW, Frew RM, Pigott JF, Zaki M (1969) Percutaneous catheterization of the internal jugular vein. Anaesthesia 24:521–523PubMedCrossRef

19.

Hayashi Y, Uchida O, Takaki O, Ohnishi Y, Nakajima T, Kataoka H, Kuro M (1992) Internal jugular vein catheterization in infants undergoing cardiovascular surgery: an analysis of factors influencing successful catheterization. Anesth Analg 74:688–693PubMedCrossRef

20.

Denda S, Mochida T, Taneoka M, Honda H, Kitahara Y, Nishimaki H (2007) Internal jugular vein cannulation guided by ultrasonography in pediatric patients undergoing cardiovascular surgery. Masui 56:69–73PubMed

21.

Karakitsos D, Labropoulos N, De Groot E, Patrianakos AP, Kouraklis G, Poularas J, Samonis G, Tsoutsos DA, Konstadoulakis MM, Karabinis A (2006) Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care 10:R162PubMedCrossRef

22.

Himmelseher S, Pfenninger E, Werner C (2001) Intraoperative monitoring in neuroanesthesia: a national comparison between two surveys in Germany in 1991, 1997. Scientific Neuroanesthesia Research Group of the German Society of Anesthesia and Intensive Care Medicine. Anesth Analg 92:166–171PubMedCrossRef

Title: Safety and efficacy of ultrasound assistance during internal jugular vein cannulation in neurosurgical infants
Authors: M. Lamperti
D. Caldiroli
P. Cortellazzi
D. Vailati
A. Pedicelli
F. Tosi
M. Piastra
D. Pietrini
Publication date: 01-11-2008
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 11/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1210-9

At a glance: The STEP trials

Springer Medicine

Safety and efficacy of ultrasound assistance during internal jugular vein cannulation in neurosurgical infants

Abstract

Objective

Design and settings

Participants

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Design and settings

Participants

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2008

The use of propofol for medium and long-term sedation in critically ill adult patients: a meta-analysis

Extravascular lung water volume measurement by a novel lithium-thermal indicator dilution method: comparison of three techniques to post-mortem gravimetry

Sleep monitoring in the intensive care unit: comparison of nurse assessment, actigraphy and polysomnography

Science, medicine and industry: are we getting out of the black hole in sepsis research?

Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients

Impact of body weight on critically ill patients: a heavy load!!