Landmark guided internal jugular vein catheterization in infants undergoing congenital heart surgery

Abstract

Objectives: Central venous catheterization is an important procedure for infants undergoing heart surgery. Ultrasound-guided methods have been shown to decrease failure and complications. The goal of the present study was investigate the effect of anatomical landmark technique during internal jugular vein access in low-weight infants undergoing congenital heart surgery.

Methods: A total 98 infants (median age was 16.5 days, median weight was 3275 g) who underwent internal jugular vein catheterization between January 2017 and October 2019 were retrospectively analyzed. All catherizations were performed by a pediatric heart surgeon. Data including demographic characteristics of the infants, success rate, and catheter-related adverse events were recorded.

Results: Success rate was 94.9% (n = 93). There were three arterial puncture (3.1%) and hematoma occurred in five patients (5.1%). Central venous catheterization of 78 (79.6%) patients were successful at the first attempt.

Conclusions: Our study suggest that landmark technique still seems useful by experienced operators and is safe and effective in infants weighing less than 5 kg undergoing congenital heart surgery.

Keywords

• Central venous catheterization
• internal jugular vein
• infants

References

1. 1. Asheim P, Mostad U, Aadahl P. Ultrasound-guided central venous cannulation in infants and children. Acta Anaesthesiol Scand 2002;46:390-2.
2. 2. Ares G, Hunter CJ. Central venous access in children: indications, devices, and risks. Curr Opin Pediatr 2017;29:340-6.
3. 3. Breschan C, Platzer M, Jost R, Stettner H, Feigl G, Likar R. Ultrasound-guided supraclavicular cannulation of the brachiocephalic vein in infants: a retrospective analysis of a case series. Paediatr Anaesth 2012;22:1062-7.
4. 4. Thompson ME. Ultrasound-guided cannulation of the brachiocephalic vein in infants and children is useful and stable. Turk J Anaesthesiol Reanim 2017;45:153-7.
5. 5. Oh C, Lee S, Seo JM, Lee SK. Ultrasound guided percutaneous internal jugular vein access in neonatal intensive care unit patients. J Pediatr Surg 2016;51:570-2.
6. 6. Gurien LA, Blakely ML, Crandall MC, Schlegel C, Rettiganti MR, Saylors ME, et al. Meta-analysis of surgeon-performed central line placement: real-time ultrasound versus landmark technique. J Trauma Acute Care Surg 2018;84:655-63.
7. 7. Bannon MP, Heller SF, Rivera M. Anatomic considerations for central venous cannulation. Risk Manag Healthc Policy 2011;4:27-39.
8. 8. Bruzoni M, Slater BJ, Wall J, St Peter SD, Dutta S. A prospective randomized trial of ultrasound- vs landmark-guided central venous access in the pediatric population. J Am Coll Surg 2013;216:939-43.

9. 9. Oulego-Erroz I, Gonzalez-Cortes R, Garcia-Soler P, Balaguer-Gargallo M, Frias-Perez M, Mayordomo-Colunga J, et al. Ultrasound-guided or landmark techniques for central venous catheter placement in critically ill children. Intensive Care Med 2018;44:61-72.
10. 10. Denys BG, Uretsky BF, Reddy PS. Ultrasound-assisted cannulation of the internal jugular vein. A prospective comparison to the external landmark-guided technique. Circulation 1993;87:1557-62.
11. 11. Gualtieri E, Deppe SA, Sipperly ME, Thompson DR. Subclavian venous catheterization: greater success rate for less experienced operators using ultrasound guidance. Crit Care Med 1995;23:692-7.
12. 12. Hilty WM, Hudson PA, Levitt MA, Hall JB. Real-time ultrasound-guided femoral vein catheterization during cardiopulmonary resuscitation. Ann Emerg Med 1997;29:331-6; discussion 7.
13. 13. Dassinger MS, Renaud EJ, Goldin A, Huang EY, Russell RT, Streck CJ, et al. Use of real-time ultrasound during central venous catheter placement: results of an APSA survey. J Pediatr Surg 2015;50:1162-7.
14. 14. Gurien LA, Blakely ML, Russell RT, Streck CJ, Vogel AM, Renaud EJ, et al. Real-time ultrasonography for placement of central venous catheters in children: a multi-institutional study. Surgery 2016;160:1605-11.
15. 15. Sigaut S, Skhiri A, Stany I, Golmar J, Nivoche Y, Constant I, et al. Ultrasound guided internal jugular vein access in children and infant: a meta-analysis of published studies. Paediatr Anaesth 2009;19:1199-206.
16. 16. Grebenik CR, Boyce A, Sinclair ME, Evans RD, Mason DG, Martin B. NICE guidelines for central venous catheterization in children. Is the evidence base sufficient? Br J Anaesth 2004;92:827-30.
17. 17. Altun D, Nurac SH, Toprak V, Eti EZ. The success rate and safety of internal jugular vein catheterization under ultrasound guidance in infants undergoing congenital heart surgery. Turk Gogus Kalp Damar Cerrahisi Derg 2019;27:23-8.
18. 18. Malbezin S, Gauss T, Smith I, Bruneau B, Mangalsuren N, Diallo T, et al. A review of 5434 percutaneous pediatric central venous catheters inserted by anesthesiologists. Paediatr Anaesth 2013;23:974-9.
19. 19. Lamperti M, Cortellazzi P, Caldiroli D. Ultrasound-guided cannulation of IJV in pediatric patients: are meta-analyses sufficient? Paediatr Anaesth 2010;20:373-4.
20. 20. Froehlich CD, Rigby MR, Rosenberg ES, Li R, Roerig PL, Easley KA, et al. Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit. Crit Care Med 2009;37:1090-6.