Right internal jugular vein venography in infants and children

Purpose-built transcatheter cavopulmonary anastomosis device requirements: Multi-modality imaging evaluation

BACKGROUND/PURPOSE

Patients with a functional single ventricle undergo multiple, palliative open-heart surgeries. This includes a superior cavopulmonary anastomosis or bidirectional Glenn shunt. A less-invasive transcatheter approach may reduce morbidity.

METHODS/MATERIALS

We analyzed pre-Glenn X-ray contrast angiography (XA), cardiac computed tomography (CT), and cardiac magnetic resonance (CMR) studies.

RESULTS

Over an eleven-year period (1/2007 - 6/2017), 139 Glenn surgeries were performed at our institution. The typical age range at surgery was 59 - 371 days (median = 163; IQR = 138 - 203). Eight-nine XA, ten CT, and ten CMR studies obtained from these patients were analyzed. Cephalad SVC measurements (millimeters) were 7.3 ± 1.7 (XA), 7.7 ± 1.6 (CT) and 6.9 ± 1.8 (CMR). RPA measurements were 7.3 ± 1.9 (XA), 7.4 ± 1.6 (CT) and 6.6 ± 1.9 (CMR). Potential device lengths were 10.9 ± 6 - 17.4 ± 6.4 (XA), 10.1 ± 2.1 - 17.7 ± 2.4 (CT) and 17.3 ± 4. - 23.7 ± 5.5 (CMR). SVC-RPA angle (degrees) was 132.9 ± 13.2 (CT) and 140 ± 10.2 (MRI). Image quality of all CT (100%), almost all XA (SVC 100%, RPA 99%), and most MRI (SVC 80%, RPA 90%) were deemed sufficient. Parametric modeling virtual fit device with 10 mm diameter and 20 - 25 mm length was ideal.

CONCLUSIONS

Ideal transcatheter cavopulmonary shunt device for the typical patient would be 10 mm in diameter and 20-25 mm in length.

Anatomical features of the right internal jugular vein in infants and young children undergoing heart surgery for congenital disease: comparison between cyanotic and noncyanotic patients

PURPOSE

It has been reported that children with cyanotic heart disease have elevated systemic levels of vascular endothelial growth factor, which may be related to the development of vessels. However, it is unknown whether the anatomical features of the internal jugular vein (IJV) differ between cyanotic and noncyanotic children. In this study, we compared anatomical information about the IJV of these two groups of patients.

METHODS

We measured the distance between the right IJV and the right carotid artery (distance), the diameter of the IJV (diameter), and the depth of the IJV from the skin (depth), using an ultrasound device, in 100 children (0-34 months) undergoing heart surgery for congenital disease. First, we evaluated the relationship of these measurement values with patient demographic data (age, height, and body weight). Next, we evaluated the effect of the 15 degrees Trendelenburg position on these measurement values.

RESULTS

There were 62 cyanotic and 38 noncyanotic patients. Distance and diameter, but not depth, were well correlated with the demographic data in both patient groups. Diameter in cyanotic patients was highly correlated with the demographic data. Clinically significant changes in the measurement values were not observed in the 15 degrees Trendelenburg position compared with the horizontal position in either patient group.

CONCLUSION

The anatomical features of the right IJV in infants and young children with congenital heart disease were not different in cyanotic and noncyanotic patients, except for the relationship between diameter and the demographic data. In the small patients examined in our study (72% of them were infants), the diameter of the IJV was not sufficiently enlarged by the Trendelenburg position, regardless of whether the patients were cyanotic or noncyanotic.

Audio-Doppler guidance using a small-caliber Doppler probe for internal jugular venous puncture for central venous catheterization in infants and children

BACKGROUND

We evaluated an audio-Doppler with a small-caliber probe as a guide for central venous cannulation (CVC) via the internal jugular vein (IJV) in infants and children.

METHODS

The right IJV was located with a small-caliber (2.0 mm in diameter) audio-Doppler probe using 10 MHz ultrasound. The probe was placed on the neck about the level of sixth cervical vertebra and was moved until the crisp pulsatile sound of the carotid artery was identified. Then the probe was moved laterally to identify the low-pitched venous hum of the right IJV. After marking the puncture site on the skin, a sterile cannulation procedure was performed. Ultimate success rate, cannulation time < 10 min, successful cannulation within three punctures, and complications were recorded.

RESULTS

Ultimate success rate was 65.6% (42/64) in infants (< 12 m), and 94.7% (72/76) in children (12 m or older). Cannulation time < 10 min was 48.4% in infants, and 85.5% in children. Successful cannulation within three punctures was 45.3% in infants and 82.8% in children. Three carotid arterial punctures occurred.

CONCLUSIONS

We were not able to demonstrate absolute superiority of the results utilizing this device over the reported results of traditional landmark techniques for CVC via the right IJV. However, this device may contribute to reducing complications and be of value in teaching residents where to insert a needle for an internal jugular puncture.

Clinical review: vascular access for fluid infusion in children

The current literature on venous access in infants and children for acute intravascular access in the routine situation and in emergency or intensive care settings is reviewed. The various techniques for facilitating venous cannulation, such as application of local warmth, transillumination techniques and epidermal nitroglycerine, are described. Preferred sites for central venous access in infants and children are the external and internal jugular veins, the subclavian and axillary veins, and the femoral vein. The femoral venous cannulation appears to be the most safe and reliable technique in children of all ages, with a high success and low complication rates. Evidence from the reviewed literature strongly supports the use of real-time ultrasound techniques for venous cannulation in infants and children. Additionally, in emergency situations the intraosseous access has almost completly replaced saphenous cutdown procedures in children and has decreased the need for immediate central venous access.