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Brusciano V, Lecce M. Advantages of the use of ultrasound in newborn vascular access: a systematic review. J Ultrasound 2024; 27:203-207. [PMID: 37801208 PMCID: PMC11178713 DOI: 10.1007/s40477-023-00832-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/03/2023] [Indexed: 10/07/2023] Open
Abstract
Vascular access in neonates and small infants is often challenging. Ultrasound (US) screening and guidance improves its safety and efficacy. The advantages of a pre-implantation ultrasound examination are intuitive; it is a practical and safe technique that doesn't use radiation, allowing static and dynamic evaluations to be carried out and identifying anatomical variations, the caliber and depth of the vessel, the patency of the entire course and attached structures (nerves, etc.). Optimization of the image is a crucial aspect in achieving a clear view of all anatomical structures while avoiding complications. The goal of this review was to look into the benefits of using US in invasive catheter insertion procedures, especially in pediatric patients. Ultrasonography is used to visualize vessels and related structures in two dimensions (2D), sometimes with the help of color Doppler to detect the presence of intraluminal thrombi by applying gentle compression to assess vessel collapse and evaluate morphologic changes in the internal jugular vein (IJV) who had undergone central venous catheter (CVC) insertion during the neonatal period (Montes-Tapia et al. in J Pediatr Surg 51:1700-1703, 2016).
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Affiliation(s)
- Valentina Brusciano
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, Naples, Italy.
| | - Miriam Lecce
- Università degli Studi della Campania-Luigi Vanvitelli, Napoli, Italy.
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Jia H, Zhang K, Han J, Liu Q, Chen P, Wang Y, Huang S. Short peripheral intravenous cannula and straight-tip guide wire in ultrasound-guided neonatal central venous catheterization. J Vasc Access 2023; 24:1332-1339. [PMID: 35360984 DOI: 10.1177/11297298221086186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Inserting a J-tip guide-wire into a vein's lumen is often difficult when using the Seldinger or modified Seldinger technique for central venous catheterization (CVC) in newborns. This study was designed to compare the efficacy and safety of guide-wire insertion using the combination of a short peripheral intravenous cannula with a straight-tip guide-wire vs. a needle with a J-tip guide-wire for ultrasound-guided (USG) cannulation of the internal jugular vein (IJV) in newborns using an in-plane technique. METHODS One hundred and thirty newborn patients (weight, 1.4-5.2 kg) scheduled for selective or emergency surgery, were randomly assigned to either the needle group (combined with a J-tip guide-wire) or cannula group (combined with a straight-tip guide-wire). The primary outcome was the rate of successful guide-wire insertion on the first attempt. The puncture attempts, catheter placement attempts, and mechanical complications were also compared between the groups. RESULTS The rate of successful guide-wire insertion on the first attempt was higher in the cannula group (97%) than in the needle group (76%) (p < 0.05, χ2 = 11.233). Moreover, fewer insertion attempts were needed in the cannula group (1.0 ± 0.2) than in the needle group (1.7 ± 1.1) (p < 0.05, 95% CI [0.449, 1.028]). The time to successful guide-wire insertion was shorter in the cannula group (63 ± 32 s) than in the needle group (92±50 s) (p < 0.05, 95% CI [14.024, 43.063]). No differences were found about other catheterization parameters and complications between the groups. CONCLUSION The short peripheral cannula combined with a straight-tip guide-wire was superior to the needle combined with a J-tip guide-wire for USG newborn IJV catheterization in terms of successful guide-wire insertion on the first attempt and overall number of insertion attempts.
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Affiliation(s)
- Haitao Jia
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Kai Zhang
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Jie Han
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Qi Liu
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Peizhang Chen
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Yingbin Wang
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Shenghui Huang
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
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Jarraya A, Kammoun M, Chtourou A, Ammar S, Kolsi K. Complications and its risk factors of percutaneous subclavian vein catheters in pediatric patients: enhancing the outcomes of a university hospital in a low-income and middle-income country. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000523. [PMID: 38328394 PMCID: PMC10848620 DOI: 10.1136/wjps-2022-000523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Assessing central venous catheter-related complications with regular feedback and investigating risk factors are mandatory to enhance outcomes. The aim of this study is to assess our experience in the management of pediatric subclavian vein catheters (SVCs) and to investigate the main risk factors for complications. Methods In this prospective observational study, we included children aged 3 months to 14 years who underwent infraclavicular subclavian vein catheterization consecutively using the anatomic landmark technique. Patients were divided into two groups: group 1 included complicated catheters and group 2 included non-complicated catheters. The management protocol was standardized for all patients. After comparing the two groups, univariate and multivariate logistic regression were used to investigate the risk factors for complications. Results In this study, we included 134 pediatric patients. The rate of complications was 32.8%. The main complications were central line-associated bloodstream infection (63.6%), bleeding and/or hematoma (22.7%), mechanical complications (13.6%), and vein thrombosis (13.6%). After adjustment for confounding factors, predictors of catheter-related complications were difficult insertion procedure (adjusted odds ratio (aOR)=9.4; 95% confidential interval (CI): 2.32 to 38.4), thrombocytopenia (aOR=4.43; 95% CI: 1.16 to 16.86), comorbidities (aOR=2.93; 95% CI: 0.58 to 14.7), and neutropenia (aOR=5.45; 95% CI: 2.29 to 13.0). Conclusions High rates of complications were associated with difficult catheter placement and patients with comorbidities and severe thrombocytopenia. To reduce catheter-related morbidity, we suggest an ultrasound-guided approach, a multidisciplinary teaching program to improve nursing skills, and the use of less invasive devices for patients with cancer.
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Affiliation(s)
- Anouar Jarraya
- The Anesthesiology department, University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Manel Kammoun
- The Anesthesiology department, University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Ameni Chtourou
- The Anesthesiology department, University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Saloua Ammar
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
- University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Kamel Kolsi
- The Anesthesiology department, University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
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Osman D, Mehmet K, Halil K. US-guided central venous catheter placement in the neonatal intensive care unit: Brachiocephalic vein or internal jugular vein? J Vasc Access 2023:11297298231152679. [PMID: 36750956 DOI: 10.1177/11297298231152679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Centrally inserted central catheters (CICCs) are commonly used to monitor venous pressure and administer parenteral nutrition and drugs in newborns. In the present study, we evaluated cannulation success rates, cannulation time, and frequency of complications in catheterization of the internal jugular vein (IJV) and brachiocephalic vein (BCV). METHODS The present study included patients who underwent IJV and BCV catheterization under ultrasound (US) guidance. The patients were divided into two groups, IJV and BCV, depending on the vein in which the CICC was utilized. We documented the diameters of the IJVs and BCVs, first attempt and overall success rates, mean cannulation time, and complication rates. RESULTS A total of 79 patients were evaluated, 37 in the BCV group and 42 in the IJV group. No significant differences were observed between the two groups in terms of sex, mean age, or weight range (p > 0.05).The mean vein diameter was significantly larger in the BCV group than in the IJV group (p < 0.001); the mean number of attempts was significantly higher in the IJV group than in the BCV group (p < 0.001); the mean cannulation time was significantly longer in the IJV group than in the BCV group (p < 0.001); and the first attempt success rate was 50% in the IJV group, versus 94.6% in the BCV group. The overall success rate was 100% in both groups. The rate of complications was 8.6% in the IJV group, while no complications developed in the BCV group. CONCLUSIONS Given the larger diameter of the vessel, BCV catheterization was found to result in quicker cannulation and lower complication rates. The results of the present study suggest that BCV catheterization should be the first choice for neonatal intensive care unit (NICU) patients who require parenteral support or close venous pressure monitoring.
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Affiliation(s)
- Dere Osman
- Department of Radiology, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Kolu Mehmet
- Department of Radiology, Dicle Memorial Hospital, Diyarbakir, Turkey
| | - Kazanasmaz Halil
- Department of Pediatrics, Harran University Faculty of Medicine, Sanliurfa, Turkey
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Thakur A, Modi M, Kler N, Garg P. Neonatologist-Performed Ultrasound-Guided Internal Jugular Vein Cannulation. Indian Pediatr 2023; 60. [PMCID: PMC9885405 DOI: 10.1007/s13312-023-2700-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We retrieved data of ultrasound-guided neonatal internal jugular vein (IJV) cannulations done between November, 2020 and March, 2021. Of the 33 ultrasound-guided IJV cannulation in neonates, 32 were successful with overall success rate of 97%. Median (IQR) number of attempts per insertion was 2 (1,3.5). There were no major complications observed during the insertion of the catheter. In one instance, inadvertent carotid artery puncture was encountered, without significant bleeding.
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Affiliation(s)
- Anup Thakur
- Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Manoj Modi
- Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Neelam Kler
- Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Pankaj Garg
- Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
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Thakur A, Modi M, Kler N, Garg P. Neonatologist-Performed Ultrasound-Guided Internal Jugular Vein Cannulation. Indian Pediatr 2023; 60:72-74. [PMID: 36639975 PMCID: PMC9885405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
We retrieved data of ultrasound-guided neonatal internal jugular vein (IJV) cannulations done between November, 2020 and March, 2021. Of the 33 ultrasound-guided IJV cannulation in neonates, 32 were successful with overall success rate of 97%. Median (IQR) number of attempts per insertion was 2 (1,3.5). There were no major complications observed during the insertion of the catheter. In one instance, inadvertent carotid artery puncture was encountered, without significant bleeding.
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Affiliation(s)
- Anup Thakur
- Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi
| | - Manoj Modi
- grid.415985.40000 0004 1767 8547Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Neelam Kler
- grid.415985.40000 0004 1767 8547Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Pankaj Garg
- grid.415985.40000 0004 1767 8547Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
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Farhadi E, Aslanabadi S, Badebarin D, Jamshidi M, Ladan AH, Hasanzadeh N, Rezaee M. Comparison of Open and Ultrasound-Guided Placement of Central Venous Catheter in Children Weighing Less Than Five Kilograms; A Randomized Clinical Trial. Acad Radiol 2022:S1076-6332(22)00547-5. [DOI: 10.1016/j.acra.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/25/2022] [Accepted: 10/09/2022] [Indexed: 11/27/2022]
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Ultrasound-guided percutaneous insertion of Broviac lines in infants less than 5kg: Prospective study of 100 consecutive procedures. J Pediatr Surg 2022; 57:534-537. [PMID: 35181123 DOI: 10.1016/j.jpedsurg.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/01/2021] [Accepted: 01/02/2022] [Indexed: 10/31/2022]
Abstract
AIM Ultrasound-guided (USG) percutaneous insertion of Broviac lines (cuffed tunnelled silastic central venous catheters, TCVC) has increasingly been adopted throughout the UK. However, vascular access remains a challenge in small babies and in some units is still performed by open cutdown. Our vascular access team, established in 2004, consists of consultant surgeons, anaesthetists and interventional radiologists, who provide all permanent vascular access by the USG technique. We reviewed the outcome in our last 100 patients less than 5 kg. METHOD A prospective database of TCVC insertions in patients <5 kg weight recorded age, gestation, weight, diagnosis, type of catheter and complications within 28 days of insertion. A standardised technique of USG insertion is used by all operators. RESULTS One-hundred patients <5 kg had TCVC inserted between 1/1/2018 and 31/3/2020. Median age 46(range0-316)days, gestation 36.5(23-42)weeks, weight 3(0.66 to 5)kg. INDICATION parenteral nutrition(75), long term antibiotics(14), cardiac medication(6), chemotherapy(3), other(2). All were tunnelled silicone lines of single 2.7fr(51) and 4.2fr(46) or double lumen 7fr(3). Uncomplicated insertion in 94/100 cases. In 6 patients difficulties were encountered with cannulating the vein. In 4 cases an experienced colleague was called and managed to cannulate the vein; in 1 case a new successful attempt was made on the opposite internal jugular vein, and in 1 the femoral vein was used. No patient required an open cutdown. There were no cases of line sepsis requiring removal but 1 replacement was required for blockage within 28days. CONCLUSION The USG approach in infants<5 kg is safe and can be used exclusively for venous access even in the most tiny babies. It is, however, a technically challenging procedure therefore we would recommend establishing a consultant delivered vascular access team to provide this service. Open venous cutdown in a tertiary children's hospital is no longer necessary for the insertion of TCVC and should be abandoned altogether. LEVELS OF EVIDENCE Level I Prognosis Study.
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Ultrasound-guided vascular access in the neonatal intensive care unit: a nationwide survey. Eur J Pediatr 2022; 181:2441-2451. [PMID: 35296915 DOI: 10.1007/s00431-022-04400-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 11/03/2022]
Abstract
UNLABELLED Ultrasound-guided vascular access (USG-VA) is recommended by international practice guidelines but information regarding its use in the neonatal intensive care unit (NICU) is lacking. Our objective was to assess neonatologist's perceptions and current implementation of USG-VA in Spain. This was a nationwide online survey. The survey was composed of 37 questions divided in 4 domains: (1) neonatologist's background, (2) NICU characteristics, (3) personal perspectives about USG-VA, and (4) clinical experience in USG-VA. One-hundred and eighty survey responses from 59 NICUs (62% of Spanish NICUs) were analyzed. Most neonatologists (81%) perceive that competence in USG-VA is indispensable or very useful in clinical practice. However, 64 (35.5%) have never used USG-VA in real patients. Among neonatologists with some experience in USG-VA most perform less than 5 procedures per year (59% in venous access and 80% in arterial access) and a 38% and 60% have never used USG for venous and arterial access, respectively, in very low birth weight infants (VLBWI). More than a half of neonatologists (55.5%) use US to check catheter tip location but a 46.6% always perform a radiography for confirmation. Spanish neonatologists report that resident/fellow training in USG-VA is absent (52.2%) or unstructured (32%) in their units. The lack of adequate training is identified by a 60% of neonatologists as the most important barrier for implementation of USG-VA and 87% would recommend that future neonatologists receive formal training. CONCLUSION Spanish neonatologists perceive that USG-VA is important in clinical practice but currently, these techniques are largely underused. Our results indicate that specific training in USG-VA should be implemented in the NICU. WHAT IS KNOWN • Ultrasound-guided vascular access is recommended as the preferred method for central venous access and arterial line placement in children and adults. • The degree of current implementation of ultrasound for vascular access in the NICU and the perceptions of neonatologist about its use are largely unknown. WHAT IS NEW • Most neonatologists consider that competence in ultrasound-guided vascular access is an indispensable aid for clinical practice. • However, most neonatologists are not adequately trained in ultrasound-guided vascular access and the technique is largely underused.
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Acosta CM, Tusman G. Ultrasound-guided brachiocephalic vein access in neonates and pediatric patients. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:584-591. [PMID: 34840101 DOI: 10.1016/j.redare.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/28/2020] [Indexed: 06/13/2023]
Abstract
Central venous accesses in neonates and pediatric patients represent a common and important procedure for both, intraoperative and postoperative care. Point-of-care ultrasound-guided technique has been proposed to increased success rate and efficiency, as well as to decrease the number of complications. Ultrasound-guided internal jugular vein cannulation is considering the "gold standard" in children. Another central venous cannulation option in neonates and children has been supraclavicular ultrasound-guided cannulation of the brachiocephalic vein using the in-plane approach. This article gives a review of the current evidence, the basic knowledge of the technique and the structured approach to follow for supraclavicular ultrasound-guided brachiocephalic vein access in children and neonates.
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Affiliation(s)
- C M Acosta
- Servicio de Anestesia, Hospital Privado de Comunidad, Mar del Plata, Buenos Aires, Argentina.
| | - G Tusman
- Servicio de Anestesia, Hospital Privado de Comunidad, Mar del Plata, Buenos Aires, Argentina
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Doğan AB, Güler AG, Yurttutan S, Öksüz G. The bedside practice of sonographic guided internal jugular vein access in critically ill premature infants. Minerva Pediatr (Torino) 2021; 74:181-187. [PMID: 34152111 DOI: 10.23736/s2724-5276.21.06180-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intrahospital transport, general anesthesia, and the prolonged duration of the central venous catheterization (CVC) in unfavorable conditions pose a significant risk to a critically-ill premature infant. We aimed to demonstrate a minimalized and safe manner of CVC in this patient population. METHODS We worked on a prospective study in 51 critically-ill premature infants in which a 22 Gauge catheter was put in one of the central thoracic veins with the guidance of sonography as a bedside procedure. Of the patients, 27 (53%) were extremely premature, and 21 (41%) were extremely low birth weight infants (ELBW). The mean gestational age was 29 ± 5 weeks, and the mean weight at the time of the procedure was 1655 ± 1028 grams. While no anesthetic and sedative drugs were administered to ELBW infants during procedures, in the remainder of the cohort, procedures were carried out only under sedoanalgesia. RESULTS Vascular access was achieved in 48 (94%) of the patients after a mean number of 1.47 ± 0.75 attempts. Body heat loss of the patients at the end of the procedures was not statistically significant (p=0.164). However, ELBW infants lost their body heat significantly more than the rest of the cohort (p=0.032). We experienced clinically insignificant common carotid artery puncture in three patients and hemothorax in one patient. CONCLUSIONS CVC of critically ill premature infants can be safely and successfully achieved in incubators using sonography guidance, protecting them from hypothermia and anesthetic drugs.
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Affiliation(s)
- Ahmet B Doğan
- Department of Pediatric Surgery, School of Medicine, Erciyes University, Kayseri, Turkey -
| | - Ahmet G Güler
- Department of Pediatric Surgery, School of Medicine, Sütçü İmam University, Kahramanmaraş, Turkey
| | - Sadık Yurttutan
- Department of Neonatology, School of Medicine, Sütçü İmam University, Kahramanmaraş, Turkey
| | - Gözen Öksüz
- Department of Anesthesiology and Reanimation, School of Medicine, Sütçü İmam University, Kahramanmaraş, Turkey
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Okumuş M, Zubarioglu AU. Ultrasound-Guided Central Venous Access With Different Anesthesia Methods in Neonatal Intensive Care Unit. Cureus 2021; 13:e15753. [PMID: 34290931 PMCID: PMC8289391 DOI: 10.7759/cureus.15753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/08/2022] Open
Abstract
Background: Ultrasound (US)-guided internal jugular vein (IJV) catheterization in newborns is usually performed in the operating room with general anesthesia. This study aimed to show that US-guided IJV catheterization can be successfully performed with local anesthesia and sedation in newborns. Methods: The files of newborn patients who underwent US-guided IJV catheterization between May 2017 and May 2020 were examined. Two groups were created according to the type of anesthesia applied during the procedure. The general characteristics of the newborns, the success of the procedure, the number of punctures, and the complication rates in both groups were compared. Results: A total of 53 newborns were included in this study. Of the 62 procedures, 30 were performed under general anesthesia (group A) and 32 were performed under sedation (group B). Twenty-six (86.6%) of the newborns in group A and 19 (59.3%) in group B were catheterized at the first puncture. The median puncture numbers in groups A and B were 1 (1-3) and 1 (1-5), respectively. All of the patients in group A were successfully catheterized (n = 30; 100%), and all but one in group B could be catheterized (n = 32; 96.8%). Conclusion: No significant differences in complications or procedural success rates were observed between newborns undergoing general anesthesia or sedation. US-guided IJV catheterization can be safely performed with sedation alone.
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Affiliation(s)
- Mustafa Okumuş
- Department of Pediatric Surgery, Yeni Yüzyıl University, Faculty of Medicine, Gaziosmanpaşa Hospital, Istanbul, TUR
| | - Adil Umut Zubarioglu
- Department of Pediatrics, Yeni Yüzyıl University, Faculty of Medicine, Gaziosmanpaşa Hospital, Istanbul, TUR
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Tan Y, Tu Z, Ye P, Xu Y, Ye M, Bai L, Liu L. Ultrasound guidance for internal jugular vein cannulation in neonates: Modified dynamic needle tip positioning short-axis out-of-plane technique versus long-axis in-plane technique, a randomized controlled trial. J Vasc Access 2021. [PMID: 33993790 DOI: 10.1177/11297298211015043 2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ultrasound-guided central venous catheter placement has significantly improved the success rate of punctures and reduced the risk of complications. However, catheterizing the internal jugular vein under ultrasound guidance in neonates remains challenging. METHODS Ninety-six patients were screened for eligibility in this randomized controlled trial between November 2018 and October 2019. After meeting the inclusion criteria, 90 term neonates undergoing cardiothoracic, general, or neurosurgery procedures were randomly assigned to the modified dynamic needle tip positioning short-axis (n = 45) or long-axis groups (n = 45) using a computer-generated random numbers table. The primary outcome was the first-attempt success rate. The secondary outcomes included the total success rate, cannulation time, and incidence of cannulation-related complications, including hematoma, accidental arterial puncture, or pneumothorax. Data were compared between the two groups. RESULTS The success rate for the first attempt was higher (88.9% vs 64.4%; p = 0.001; relative risk, 1.4; 95% confidence interval, 1.1-1.8), while the cannulation time was shorter (171.0 ± 47.8 s vs 304.4 ± 113.5 s; p = 0.001; estimated difference, -133.4; 95% confidence interval, -170.1 to -96.7), in the modified dynamic needle tip positioning short-axis group compared with the long-axis group. Six hematomas and two common carotid artery punctures were identified in the long-axis group, while none were identified in the modified dynamic needle tip positioning short-axis group. CONCLUSIONS The modified dynamic needle tip positioning short-axis out-of-plane technique enhanced the procedural efficacy and safety of internal jugular vein catheterization in neonates.
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Affiliation(s)
- Yanzhe Tan
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders, Chongqing, P.R. China
| | - Zhenzhen Tu
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China
| | - Ping Ye
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, P.R. China
| | - Ying Xu
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Mao Ye
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Lin Bai
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
| | - Lifei Liu
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders, Chongqing, P.R. China
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Tan Y, Tu Z, Ye P, Xu Y, Ye M, Bai L, Liu L. Ultrasound guidance for internal jugular vein cannulation in neonates: Modified dynamic needle tip positioning short-axis out-of-plane technique versus long-axis in-plane technique, a randomized controlled trial. J Vasc Access 2021; 23:922-929. [PMID: 33993790 DOI: 10.1177/11297298211015043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Ultrasound-guided central venous catheter placement has significantly improved the success rate of punctures and reduced the risk of complications. However, catheterizing the internal jugular vein under ultrasound guidance in neonates remains challenging. METHODS Ninety-six patients were screened for eligibility in this randomized controlled trial between November 2018 and October 2019. After meeting the inclusion criteria, 90 term neonates undergoing cardiothoracic, general, or neurosurgery procedures were randomly assigned to the modified dynamic needle tip positioning short-axis (n = 45) or long-axis groups (n = 45) using a computer-generated random numbers table. The primary outcome was the first-attempt success rate. The secondary outcomes included the total success rate, cannulation time, and incidence of cannulation-related complications, including hematoma, accidental arterial puncture, or pneumothorax. Data were compared between the two groups. RESULTS The success rate for the first attempt was higher (88.9% vs 64.4%; p = 0.001; relative risk, 1.4; 95% confidence interval, 1.1-1.8), while the cannulation time was shorter (171.0 ± 47.8 s vs 304.4 ± 113.5 s; p = 0.001; estimated difference, -133.4; 95% confidence interval, -170.1 to -96.7), in the modified dynamic needle tip positioning short-axis group compared with the long-axis group. Six hematomas and two common carotid artery punctures were identified in the long-axis group, while none were identified in the modified dynamic needle tip positioning short-axis group. CONCLUSIONS The modified dynamic needle tip positioning short-axis out-of-plane technique enhanced the procedural efficacy and safety of internal jugular vein catheterization in neonates.
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Affiliation(s)
- Yanzhe Tan
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders, Chongqing, P.R. China
| | - Zhenzhen Tu
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China
| | - Ping Ye
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, P.R. China
| | - Ying Xu
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Mao Ye
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Lin Bai
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
| | - Lifei Liu
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders, Chongqing, P.R. China
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15
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Tan Y, Liu L, Tu Z, Xu Y, Xie J, Ye P. Distal superficial femoral vein versus axillary vein central catheter placement under ultrasound guidance for neonates with difficult access: A randomized clinical trial. J Vasc Access 2021; 22:642-649. [PMID: 33908297 DOI: 10.1177/11297298211011867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Epicutaneo-caval catheters (ECCs) are extensively used in premature and ill neonates. This prospective, randomized, observational study aimed to compare the outcomes of ECC placement in the distal superficial femoral and axillary veins in neonates with difficult ECC access. METHODS In a neonatal intensive care unit at a tertiary referral center, 60 neonates with difficult ECC access were randomized into two groups with catheters placed using the ultrasound-guided modified dynamic needle tip positioning (MDNTP) technique: distal superficial femoral vein (DSFV) and axillary vein (AV) groups. RESULTS The first attempt success rate was significantly higher in the DSFV group than in the AV group [23/30 (76.7%) vs 11/30 (36.7%), p = 0.001; odds ratio (OR), 0.176; 95% confidence interval (CI) 0.057-0.543]. The mean procedural duration was significantly shorter in the DSFV group than in the AV group [mean: 308.5 (standard deviation: 81.1) s vs 522.74 (134.8) s, t = -7.17, p < 0.001]. The incidence of complications was significantly lower in the DSFV group than in the AV group [4/30 (13.3%) vs 12/30 (40.0%), p = 0.019; OR, 4.333; 95% CI 1.203-15.604]. The number of attempts was significantly fewer in the DSFV group than in the AV group (p = 0.012). CONCLUSIONS The distal superficial femoral and axillary veins are two alternative and safe access points for ECC placement in premature neonates (weight < 2.5 kg) with difficult access. However, access through the distal superficial femoral vein was quicker, easier, and had fewer complications than through the axillary vein.
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Affiliation(s)
- Yanzhe Tan
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Lifei Liu
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Zhenzhen Tu
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Ying Xu
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Jia Xie
- Department of Neonatal Intensive Care Unit, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Ping Ye
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
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16
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Acosta CM, Tusman G. Ultrasound-guided brachiocephalic vein access in neonates and pediatric patients. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:S0034-9356(20)30299-1. [PMID: 33931264 DOI: 10.1016/j.redar.2020.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/25/2020] [Accepted: 10/28/2020] [Indexed: 06/12/2023]
Abstract
Central venous accesses in neonates and pediatric patients represent a common and important procedure for both, intraoperative and postoperative care. Point-of-care ultrasound-guided technique has been proposed to increased success rate and efficiency, as well as to decrease the number of complications. Ultrasound-guided internal jugular vein cannulation is considering the "gold standard" in children. Another central venous cannulation option in neonates and children has been supraclavicular ultrasound-guided cannulation of the brachiocephalic vein using the in-plane approach. This article gives a review of the current evidence, the basic knowledge of the technique and the structured approach to follow for supraclavicular ultrasound-guided brachiocephalic vein access in children and neonates.
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Affiliation(s)
- C M Acosta
- Servicio de Anestesia, Hospital Privado de Comunidad, Mar del Plata, Buenos Aires, Argentina.
| | - G Tusman
- Servicio de Anestesia, Hospital Privado de Comunidad, Mar del Plata, Buenos Aires, Argentina
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17
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Liu W, Tu Z, Liu L, Tan Y. Combined short- and long-axis method for internal jugular vein catheterization in premature newborns: A randomized controlled trial. Acta Anaesthesiol Scand 2021; 65:420-427. [PMID: 33147353 DOI: 10.1111/aas.13728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/16/2020] [Accepted: 10/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rapid central venous catheterization is critical for the rescue and perioperative management of premature infants requiring surgery. Ultrasound-guided dynamic needle tip positioning (DNTP) has been widely used as a very effective technique, especially in paediatric vascular puncture and catheterization. However, for low-weight premature newborns, central vein catheterization still poses greater difficulties for paediatricians and paediatric anaesthesiologists. This prospective randomized control study aimed to evaluate the efficacy of combined short- and long-axis (CSLA) internal jugular vein catheterization for premature newborns in comparison with the DNTP technique. METHODS A total of 90 premature newborns (gestational age < 37 weeks and < 28 days after birth) who were scheduled for surgery were included in this study. All enrolled premature newborns were randomly divided into two groups (n = 45): the CSLA group and the DNTP group. We compared the first-puncture success rate, total success rate, procedure time, number of needle passes, occurrence of complications and other outcome measures between the two groups. RESULTS The two groups (n = 45 per group) were similar in sex, gestational age, weight, mean arterial blood pressure, and vein-related measurements of the internal jugular vein. Total success was achieved in 43 (95.6%) and 36 (80.0%) patients in the CSLA and DNTP groups respectively. Compared with the DNTP group, the CSLA group showed a significantly higher first-attempt success rate (71.1% vs 46.7%, χ2 = 5.5533, P = .0184) and significantly fewer needle passes (1.0[1.0-2.0] vs 2.0[1.0-3.0], χ2 = -2.6094, P = .0091). There was no significant difference between the groups in the procedure time (368[304-573] vs 478[324-79]s, Z = -1.7690, P = .0769). Complications occurred in both groups, but the incidence was significantly lower in the CSLA group than in the DNTP group (6.7% vs 22.2%, χ2 = 4.4056, P = .0358). CONCLUSIONS Ultrasound-guided internal jugular vein catheterization by the CSLA method is effective and safe. The CSLA method may be superior to the DNTP technique in premature newborns.
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Affiliation(s)
- Wei Liu
- Department of Anesthesiology Children’s Hospital of Chongqing Medical University Chongqing China
- National Clinical Research Center for Child Health and Disorders (Chongqing) Chongqing China
| | - Zhenzhen Tu
- Department of Anesthesiology Children’s Hospital of Chongqing Medical University Chongqing China
- Ministry of Education Key Laboratory of Child Development and Disorders Chongqing China
| | - Lifei Liu
- Department of Anesthesiology Children’s Hospital of Chongqing Medical University Chongqing China
- Ministry of Education Key Laboratory of Child Development and Disorders Chongqing China
- Chongqing Key Laboratory of Pediatrics Chongqing China
- China International Science and Technology Cooperation base of Child development and Critical Disorders Children’s Hospital of Chongqing Medical University Chongqing P.R. China
| | - Yanzhe Tan
- Department of Anesthesiology Children’s Hospital of Chongqing Medical University Chongqing China
- Ministry of Education Key Laboratory of Child Development and Disorders Chongqing China
- Chongqing Key Laboratory of Pediatrics Chongqing China
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18
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Reply to Letter to the Editor Regarding Predicting the Optimal Depth of Ultrasound-Guided Right Internal Jugular Vein Central Venous Catheters in Neonates. J Pediatr Surg 2021; 56:639. [PMID: 33199057 DOI: 10.1016/j.jpedsurg.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 11/20/2022]
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19
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van Tonder DJ, Keough N, van Niekerk ML, van Schoor AN. The position of the common facial vein in neonates: An alternate route for central venous catheter placement. Clin Anat 2020; 34:644-650. [PMID: 32986893 DOI: 10.1002/ca.23685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 08/20/2020] [Accepted: 09/15/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION We determine the location of the common facial vein (CFV) in a sample of neonates and assess the safety of this vein as an alternative access route for a central venous catheter (CVC). MATERIALS AND METHODS We dissected both the left and right sides of the neck region in 24 neonatal, formalin-fixed cadavers, exposing the underlying soft tissues and neurovascular structures. We identified the CFV, which we then pinned together with the internal jugular vein, cervical branch of facial nerve, marginal mandibular branch of the facial nerve, the cricoid cartilage, brachiocephalic vein, and the mastoid and sternal attachments of the sternocleidomastoid muscle. We measured the CFV and the related pinned structures. RESULTS In neonates, the CFV intersected the anterior border of sternocleidomastoid on average 19.53 mm (left) and 21.73 mm (right) from its sternal attachment. CONCLUSION We found the CFV inferior to the upper one third and just superior to half of the length of the sternocleidomastoid muscle, indicating a possible "safe-zone" where a skin incision could be made over the anteromedial border of sternocleidomastoid. The CFV is easily identified from surrounding landmarks. It could be used as a safe, alternative route for inserting a CVC if its average length (8.72 mm) and diameter (1.50 mm) are taken into account.
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Affiliation(s)
- Daniël J van Tonder
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Natalie Keough
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Department of Anatomy and Cellular Biology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Martin L van Niekerk
- Department of Paediatric Surgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Albert N van Schoor
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Montes-Tapia F, Hernández-Trejo K, García-Rodríguez F, Jaime-Reyes J, Treviño-Garza C, Cárdenas-Del Castillo B, Rodríguez-Balderrama I, de la O-Cavazos M. Predicting the optimal depth of ultrasound-guided right internal jugular vein central venous catheters in neonates. J Pediatr Surg 2020; 55:1920-1924. [PMID: 31937448 DOI: 10.1016/j.jpedsurg.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Poor positioning of a central venous catheter (CVC) can cause severe complications. The objective is to create a formula that predicts the optimal insertion depth of a real time ultrasound-guided CVC in the right internal jugular vein (RIJV) in newborns. METHODS Between 2015 and 2017, 91 newborns that required a CVC were included in a prospective observational study. Variables such as gestational age, gender, weight, height, and neck length were studied. On the chest x-ray, the distance between the insertion site on the skin and the catheter tip was measured. RESULTS Of the patients included, 50 (54.9%) were males and 40 (44.4%) females; 64 (70.3%) were preterm. Mean gestational age was 33.44 (25 to 41) weeks, weight 2020 (580 to 3980) g, and height 43.04 (26 to 53) cm. Variables were correlated with catheter length and an algorithm was modeled for the introduction method, in which the highest corrected determination coefficient was obtained for weight (R2 = 0.723). CONCLUSION This study demonstrated that the weight of the newborn was the most significant individual predictor of optimal insertion depth of a CVC in the RIJV. The formula Y = 2.6 + 0.7 (weight in kg) that we suggest is practical and reproducible. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Fernando Montes-Tapia
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Pediatric Surgery, Department of Pediatrics, Monterrey, Mexico.
| | - Karla Hernández-Trejo
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Department of Pediatrics, Monterrey, Mexico
| | - Fernando García-Rodríguez
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Department of Pediatrics, Monterrey, Mexico
| | - Julio Jaime-Reyes
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Department of Pediatrics, Monterrey, Mexico
| | - Consuelo Treviño-Garza
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Department of Pediatrics, Monterrey, Mexico
| | - Barbara Cárdenas-Del Castillo
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Neonatology, Department of Pediatrics, Monterrey, Mexico
| | - Isaías Rodríguez-Balderrama
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Neonatology, Department of Pediatrics, Monterrey, Mexico
| | - Manuel de la O-Cavazos
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Department of Pediatrics, Monterrey, Mexico
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21
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Uzumcugil F, Ekinci S. Ultrasound-guided anatomical evaluation of right internal jugular vein in children aged 0-2 years: A prospective observational study. Paediatr Anaesth 2020; 30:934-940. [PMID: 32618403 DOI: 10.1111/pan.13961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/10/2020] [Accepted: 06/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The right internal jugular vein is commonly preferred for central venous cannulation, and ultrasonographic assessment and guidance is the recommended technique for this procedure. Despite the safety and reliability of this technique, it requires specific training and experience as well as thorough knowledge of anatomy. AIM The position of the right internal jugular vein with respect to carotid artery and its transverse diameter free from overlap with the carotid artery were evaluated using ultrasound in patients aged 0-2 years. METHODS This single-center, prospective, observational study included patients aged 0-2 years who underwent elective surgery between July 2018 and July 2019. The diameters and anatomical position were evaluated using ultrasound. All parameters were compared between groups classified according to postmenstrual ages. The correlations of these parameters with weight and postmenstrual ages were analyzed. RESULTS A total of 156 patients were included. The diameters (P < .001) and depth (P = .012) were smaller in patients with postmenstrual age <45 weeks. The anteroposterior diameter was significantly correlated with weight in patients with postmenstrual age <45 weeks, but not in older patients. Right internal jugular vein was lateral and anterolateral with respect to carotid artery in 51.3% and 42.9% of patients, respectively, and >80% of the transverse diameter was free from overlap with the carotid artery. CONCLUSION Our results support the current data for the high anatomical variability of the right internal jugular vein, highlighting the recommendation of the Rapid Central Vein Assessment (RaCeVA) protocol prior to and ultrasound guidance during catheterization of central veins.
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Affiliation(s)
- Filiz Uzumcugil
- Department of Anesthesiology and Reanimation, Hacettepe University School of Medicine, Ankara, Turkey
| | - Saniye Ekinci
- Department of Pediatric Surgery, Hacettepe University School of Medicine, Ankara, Turkey
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Breschan C, Graf G, Arneitz C, Stettner H, Feigl G, Neuwersch S, Stadik C, Koestenberger M, Holasek S, Likar R. Feasibility of the ultrasound-guided supraclavicular cannulation of the brachiocephalic vein in very small weight infants: A case series. Paediatr Anaesth 2020; 30:928-933. [PMID: 32449570 DOI: 10.1111/pan.13928] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/06/2020] [Accepted: 05/15/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The aim of this retrospective analysis was to evaluate the clinical feasibility of the supraclavicular ultrasound-guided cannulation of the brachiocephalic vein in infants weighing less than 1500 g. METHODS The ultrasound probe was placed in the supraclavicular region so as to obtain the optimum sonographic long-axis view of the brachiocephalic vein. By using an in-plane approach the brachiocephalic vein was cannulated by using a 24-gauge intravenous cannula under real-time ultrasound guidance into the vein followed by the insertion of a 2-French single lumen catheter using the Seldinger technique. RESULTS Forty-six brachiocephalic vein cannulations in infants weighing between 0.55 and 1.5 kg (Median: 1.2; 95%-CI: 0.9-1.2) were included. Ultimate success rate was 89.1% (41 out of 46). One cannulation attempt was required in 30 (65.2%) patients, 2 in 6 (13%) and 3 in 5 (10.8%), respectively. Smaller weight babies did not require significantly more cannulation attempts. The probability of successful cannulation on the first attempt increased significantly from 40% (2010) to more than 80% (2019) over the time course of this series. Median catheter dwell time was 15 days (95%-CI: 9-20) with one catheter being removed prematurely after 8 days due to obstruction. CONCLUSION Supracalvicular in-plane real-time ultrasound-guided cannulation of the brachiocephalic vein seems to be a convenient and feasible option to provide large-bore central venous access for very small and sick babies.
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Affiliation(s)
| | - Gudrun Graf
- Department of Anesthesia, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Christoph Arneitz
- Department of Pediatric Surgery, Medical University of Graz, Graz, Austria
| | - Haro Stettner
- Department of Statistics, University of Klagenfurt, Klagenfurt, Austria
| | - Georg Feigl
- Department of Anatomy, Medical University of Graz, Graz, Austria
| | - Stefan Neuwersch
- Department of Neurorehabilitation, Krankenhaus Hermagor, Hermagor, Austria
| | - Christian Stadik
- Department of Anesthesia, Klinikum Klagenfurt, Klagenfurt, Austria
| | | | - Sandra Holasek
- Institute of Pathophysiology, Medical University of Graz, Graz, Austria
| | - Rudolf Likar
- Department of Anesthesia, Klinikum Klagenfurt, Klagenfurt, Austria
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Luo F, Cheng X, Lou X, Wang Q, Fan X, Chen S. Insertion of a 1.9F central venous catheter via the internal jugular vein in neonates. J Int Med Res 2020; 48:300060520925380. [PMID: 32552205 PMCID: PMC7303769 DOI: 10.1177/0300060520925380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/17/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study aimed to develop a technique for placing a 1.9 French (F) central venous catheter in the internal jugular vein of newborns. METHODS In this retrospective study, punctures were performed with a modified ultrasound-guided Seldinger technique with 57 1.9F catheters in 48 newborns. Punctures were performed in the right internal jugular vein in 43 (75.4%) patients and in the left internal jugular vein in 14 (24.6%) patients. RESULTS We included 33 (57.9%) boys and 24 (42.1%) girls, aged a median 38 days (range, 2-135 days). The puncture success rate was 100%. Catheterization duration was a median 14 days (range, 1-70 days). Among the catheters, 94.1% were removed after completion of therapy or upon death. Fifty-three (93%) patients experienced no complication, whereas a small amount of bleeding was observed in 2 (3.5%) patients, inflammation of puncture in 1 (1.8%) patient, and occlusion in 1 (1.8%) patient. The method of placement of 1.9F catheters in the internal jugular vein of newborns had a high success rate, with minimal trauma and few complications. CONCLUSIONS Our method of placing a 1.9F central venous catheter in the internal jugular vein is suggested for level III to VI neonatal intensive care units.
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Affiliation(s)
- Feixiang Luo
- Neonatal Intensive Care Unit, The Children's Hospital, Zhejiang
University School of Medicine, Hangzhou, Zhejiang, China
- National Clinical Research Center for Child Health, Hangzhou,
Zhejiang, China
| | - Xiaoying Cheng
- Quality Management Office, The Children's Hospital, Zhejiang
University School of Medicine, Hangzhou, Zhejiang, China
- National Clinical Research Center for Child Health, Hangzhou,
Zhejiang, China
| | - Xiaofang Lou
- Nursing Department, The Children's Hospital, Zhejiang University
School of Medicine, Hangzhou, Zhejiang, China
- National Clinical Research Center for Child Health, Hangzhou,
Zhejiang, China
| | - Qin Wang
- Neonatal Intensive Care Unit, The Children's Hospital, Zhejiang
University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaoyan Fan
- Neonatal Intensive Care Unit, The Children's Hospital, Zhejiang
University School of Medicine, Hangzhou, Zhejiang, China
| | - Shuohui Chen
- Nursing Department, The Children's Hospital, Zhejiang University
School of Medicine, Hangzhou, Zhejiang, China
- National Clinical Research Center for Child Health, Hangzhou,
Zhejiang, China
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24
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European Society of Anaesthesiology guidelines on peri-operative use of ultrasound-guided for vascular access (PERSEUS vascular access). Eur J Anaesthesiol 2020; 37:344-376. [DOI: 10.1097/eja.0000000000001180] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Singh Y, Tissot C, Fraga MV, Yousef N, Cortes RG, Lopez J, Sanchez-de-Toledo J, Brierley J, Colunga JM, Raffaj D, Da Cruz E, Durand P, Kenderessy P, Lang HJ, Nishisaki A, Kneyber MC, Tissieres P, Conlon TW, De Luca D. International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care 2020; 24:65. [PMID: 32093763 PMCID: PMC7041196 DOI: 10.1186/s13054-020-2787-9] [Citation(s) in RCA: 281] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is nowadays an essential tool in critical care. Its role seems more important in neonates and children where other monitoring techniques may be unavailable. POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) aimed to provide evidence-based clinical guidelines for the use of POCUS in critically ill neonates and children. METHODS Creation of an international Euro-American panel of paediatric and neonatal intensivists expert in POCUS and systematic review of relevant literature. A literature search was performed, and the level of evidence was assessed according to a GRADE method. Recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. AGREE statement was followed to prepare this document. RESULTS Panellists agreed on 39 out of 41 recommendations for the use of cardiac, lung, vascular, cerebral and abdominal POCUS in critically ill neonates and children. Recommendations were mostly (28 out of 39) based on moderate quality of evidence (B and C). CONCLUSIONS Evidence-based guidelines for the use of POCUS in critically ill neonates and children are now available. They will be useful to optimise the use of POCUS, training programs and further research, which are urgently needed given the weak quality of evidence available.
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Affiliation(s)
- Yogen Singh
- Department of Paediatrics - Neonatology and Paediatric Cardiology, Cambridge University Hospitals and University of Cambridge School of Clinical Medicine, Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
- Addenbrooke's Hospital, Box 402, Cambridge, UK.
| | - Cecile Tissot
- Paediatric Cardiology, Centre de Pédiatrie, Clinique des Grangettes, Geneva, Switzerland
| | - María V Fraga
- Department of Paediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, USA
| | - Nadya Yousef
- Division of Paediatrics and Neonatal Critical Care, APHP - Paris Saclay University Hospitals, "A. Béclère" Medical centre, Paris, France
| | - Rafael Gonzalez Cortes
- Department of Paediatric Intensive Care, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Jorge Lopez
- Department of Paediatric Intensive Care, Gregorio Marañón General University Hospital, Madrid, Spain
| | | | - Joe Brierley
- Department of Paediatric Intensive Care, Great Ormond Street Hospital, London, UK
| | - Juan Mayordomo Colunga
- Department of Paediatric Intensive Care, Hospital Universitario Central de Asturias, Oviedo. CIBER-Enfermedades Respiratorias. Instituto de Salud Carlos III, Madrid. Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Dusan Raffaj
- Department of Paediatric Intensive Care, Nottingham University Hospitals, Nottingham, UK
| | - Eduardo Da Cruz
- Department of Paediatric and Cardiac Intensive Care, Children's Hospital Colorado, Aurora, USA
| | - Philippe Durand
- Division of Paediatric Critical Care, APHP - Paris Saclay University Hospitals, "Kremlin Bicetre" Medical Centre, Paris, France
| | - Peter Kenderessy
- Department of Paediatric Anaesthesia and Intensive Care, Children's Hospital Banska Bystrica, Banska Bystrica, Slovakia
| | - Hans-Joerg Lang
- Department of Paediatrics, Medicins Sans Frontieres (Suisse), Geneva, Switzerland
| | - Akira Nishisaki
- Department of Anaesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, USA
| | - Martin C Kneyber
- Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pierre Tissieres
- Division of Paediatric Critical Care, APHP - Paris Saclay University Hospitals, "Kremlin Bicetre" Medical Centre, Paris, France
| | - Thomas W Conlon
- Department of Anaesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, USA
| | - Daniele De Luca
- Division of Paediatrics and Neonatal Critical Care, APHP - Paris Saclay University Hospitals, "A. Béclère" Medical centre, Paris, France
- Physiopathology and Therapeutic Innovation Unit-INSERM Unit U999, South Paris Medical School, Paris Saclay University, Paris, France
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Uzumcugil F, Yilbas AA, Akca B. Ultrasound-guided anatomical evaluation and percutaneous cannulation of the right internal jugular vein in infants <4000 g. J Vasc Access 2019; 21:92-97. [PMID: 31081445 DOI: 10.1177/1129729819845620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The commonly preferred right internal jugular vein was investigated in terms of its dimensions, the relationship between its dimensions and anthropometric measures, and the outcomes of its cannulation in infants. Data regarding its position with respect to the carotid artery indicated anatomical variation. AIM The aim of this study was to share our observations pertaining to the anatomy and position of the right internal jugular vein with respect to carotid artery using ultrasound and our experience with ultrasound-guided right internal jugular vein access in neonates and small infants. MATERIALS AND METHODS A total of 25 neonates and small infants (<4000 g) undergoing ultrasound-guided central venous cannulation via right internal jugular vein within a 6-month period were included. Ultrasound-guided anatomical evaluation of the vein was used to obtain the transverse and anteroposterior diameters, the depth from skin and the position with respect to the carotid artery. Real-time ultrasound-guided central cannulation success rates and complication rates were also obtained. The patients were divided into two groups with respect to their weight in order to compare both the position and the dimensions of right internal jugular vein and cannulation performance in infants weighing <2500 g and ⩾2500 g. RESULTS The position was lateral to the carotid artery in 84% of all infants and similar in both groups. The first-attempt success rates of cannulation were similar (70% vs 73.3%) in both groups, with an overall success rate of 88%. CONCLUSION Right internal jugular vein revealed a varying position with respect to carotid artery with a higher rate of lateral position. The presence of such anatomical variation requires ultrasonographic evaluation prior to interventions and real-time guidance during interventions involving right internal jugular vein.
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Affiliation(s)
- Filiz Uzumcugil
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Aysun Ankay Yilbas
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Basak Akca
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Mastroianni R, Capasso A, Ausanio G. The intracavitary electrocardiography method for tip location of jugular internal vein access device in infants of less than 5 kg: A pilot study. J Vasc Access 2018; 19:639-643. [DOI: 10.1177/1129729818769028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: This is a prospective observational study conducted by neonatologists in neonatal intensive care unit from Sant’Anna and San Sebastiano Hospital, Caserta, Italy. The objective of the study is to verify the feasibility of intracavitary electrocardiography method for tip location of central venous access device in infants of less than 5 kg and evaluate the accuracy of the method in comparison with post-procedural echocardiographical verification of the tip position. Patients and methods: We enrolled 27 patients weighted between 0.660 and 5 kg, requiring central vascular access. Ultrasound-guided jugular internal vein access was used and after cannulation, we applied the intracavitary electrocardiography for tip location as well as post-procedural echocardiography. Results: No significant complication related to intracavitary electrocardiography occurred in the studied infants. The increase in P wave on intracavitary electrocardiography was detected in all cases (27/27). In only one case (false positive), the catheter had the tip out of cavoatrial junction–target zone (to post-procedural echocardiography). Conclusion: The intracavitary electrocardiography method for tip location of central venous access device is safe and accurate in infants, as demonstrated by post-procedural comparative echocardiographic controls. As an alternative to echocardiography, not always achievable, the diffusion of intracavitary electrocardiography method could reduce X-ray exposition and complications of a malpositioned tip.
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Affiliation(s)
- Rossella Mastroianni
- Neonatal Intensive Care Unit, Sant’Anna and San Sebastiano Hospital, Caserta, Italy
| | - Antonella Capasso
- Neonatal Intensive Care Unit, Sant’Anna and San Sebastiano Hospital, Caserta, Italy
| | - Gaetano Ausanio
- Neonatal Intensive Care Unit, Sant’Anna and San Sebastiano Hospital, Caserta, Italy
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Rivera-Tocancipá D, Díaz-Sánchez E, Montalvo-Arce CA. Ultrasound versus anatomical landmarks: Immediate complications in the central venous catheterization in children under 18 years of age. ACTA ACUST UNITED AC 2018; 65:366-372. [PMID: 29627071 DOI: 10.1016/j.redar.2018.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/05/2017] [Accepted: 02/15/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The insertion of a central venous line in children and adolescents is technically more difficult, due to the smaller size of the structures. This can lead to an increase in immediate complications, which can be reduced when using ultrasound. In our institution, the percentage of these complications and the use of ultrasound are unknown. OBJECTIVE To describe the frequency of immediate complications of central venous catheterisation guided by the ultrasound in a general university hospital, compared to the anatomical landmarks technique in children less than 18years of age. MATERIALS AND METHODS Observational, retrospective, and analytical study, comparing the frequency of complications with two central venous catheterisation techniques: anatomical landmarks and ultrasound, according to the clinical records of procedures performed from June to November 2016. RESULTS A total of 201 procedural records were analysed, of which 71% were with landmarks, and 29% with ultrasound. The overall incidence of immediate complications was 18.4%, with 12% using ultrasound and 21% using landmarks (OR: 0.5; 95%CI: 0.2-1.2). Children under 5years of age presented with 90% of the complications, the most frequent being the impossibility of passing the guide (29.7%) and multiple punctures (24.3%). There was no arterial puncture with use of ultrasound. Ultrasound was used by 13.4% of paediatric surgeons, by 32.4% of paediatricians, and 46.4% of anaesthetists, with complications of 25%, 19%, and 7%, respectively. The main indication for catheterisation was the need for vasoactive agents (74%), with the procedure being more complicated in patients with no peripheral venous accesses (46%). The success rate with anatomical landmarks was 77.6%, compared to 91.4% with ultrasound. CONCLUSION Central venous catheterisation with ultrasound guidance in children under 18 reduces immediate complications by 42.8% and improves the success rate by 13.8%.
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Affiliation(s)
- D Rivera-Tocancipá
- Servicio de Anestesiología y Reanimación, Hospital Universitario Hernando Moncaleano Perdomo, Universidad Surcolombiana, Neiva, Huila, Colombia
| | - E Díaz-Sánchez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Hernando Moncaleano Perdomo, Universidad Surcolombiana, Neiva, Huila, Colombia.
| | - C A Montalvo-Arce
- Unidad Epidemiología-Bioestadística, Universidad Surcolombiana, Neiva, Huila, Colombia
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Teng Y, Ou M, Yu H. Feasibility of the Use of Transesophageal Echocardiography as a Surface Probe for Puncturing and Catheterization of the Internal Jugular Vein: A Randomized Controlled Pilot Study. J Cardiothorac Vasc Anesth 2018; 32:363-369. [DOI: 10.1053/j.jvca.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Indexed: 11/11/2022]
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30
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A Retrospective Analysis of the Clinical Effectiveness of Supraclavicular, Ultrasound-guided Brachiocephalic Vein Cannulations in Preterm Infants. Anesthesiology 2018; 128:38-43. [DOI: 10.1097/aln.0000000000001871] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Background
The aim of this retrospective analysis was to evaluate the clinical effectiveness of the supraclavicular ultrasound-guided cannulation of the brachiocephalic vein in preterm infants.
Methods
The ultrasound probe was placed in the supraclavicular region so as to obtain the optimum sonographic long-axis view of the brachiocephalic vein. By using a strict in-plane approach the brachiocephalic vein was cannulated by advancing a 22- or 24-gauge iv cannula from lateral to medial under the long axis of the ultrasound probe under real-time ultrasound guidance into the vein.
Results
One hundred and forty-two cannulations in infants weighing between 0.59 and 2.5 kg (median: 2.1; CI: 2.0 to 2.2) were included. Ultimate success rate was 94% (134 of 142). One cannulation attempt was required in 100 (70%) patients, two attempts in 21 (15%), and three attempts in 13 (9%). The smaller the weight of the infant the more attempts were needed. More attempts also were needed for the right brachiocephalic vein, which was primarily targeted in 75 (53%) neonates. One (1%) inadvertent arterial puncture was noted.
Conclusions
This supraclavicular, in-plane, real-time, ultrasound-guided cannulation of the brachiocephalic vein seems to be a convenient and effective method to insert central venous catheters in preterm infants.
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Abstract
PURPOSE OF REVIEW Central venous catheters (CVCs) have a prominent role in the diagnostic and therapy of neonates and children. Herein, we describe the multiple indications for CVC use and the different devices available for central venous access. Given the prevalent use of CVCs, healthcare systems are focused on reducing complications from their use, particularly central line-associated bloodstream infections (CLABSIs). The most up-to-date information available sheds light on best practices and future areas of investigation. RECENT FINDINGS Large systematic reviews of randomized trials suggest that ultrasound guidance for placement of CVCs in children is safer than using blind technique, at least for internal jugular vein access. Appropriate catheter tip placement is associated with decreased complications. Furthermore, the prophylactic use of ethanol lock between cycles of parenteral nutrition administration has reduced the rates of CLABSI. A recent randomized trial in pediatric CVCs showed a benefit with antibiotic-coated CVCs. SUMMARY Based on the available evidence, multiple techniques for CVC placement are still valid, including the landmark technique based on practitioner experience, but ultrasound guidance has been shown to decrease complications from line placement. Adherence to CVC care protocols is essential in reducing infectious complications.
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