Central venous access via external jugular vein in children

Cannulation via the external jugular vein--An alternative to conventional peripherally inserted central catheterisation for paediatric patients

PURPOSE

This study aimed to describe a peripherally inserted central catheterisation (PICC) for paediatric patients with inaccessible access and a high risk of general anaesthesia (GA).

METHODS

This was a retrospective observational study involving all paediatric inpatients who performed the PICC via an EJV approach without GA between September 2014 and September 2021 in a provincial key clinical speciality.

RESULTS

A total of 290 EJV line placement attempts were performed, and 29 were excluded due to missing placement results, resulting in a sample size of 261. The anatomical localisation, punctures, and catheterisation success rates for this practice were 100%, 100%, and 90.04%, respectively. The placement success rate in children younger than one year was 93.75% (45/48). The median line duration of use was 19 days, with a median length of catheter insertion of 13 cm. The most common complications were catheter malposition (n = 20) and dislodgement (n = 7).

CONCLUSION

The PICC via an EJV approach without GA is a feasible and safe practice with acceptable success and complication rates, and low costs. It might be an attractive alternative for obtaining central vascular access for paediatric patients.

Retrospective analysis of the feasibility and safety of external jugular vein cannulation in surgical patients

BACKGROUND

Establishing intravenous (IV) access is an essential procedure in surgical patients. External jugular vein (EJV) cannulation can be a good alternative for patients forwhom it is difficult to establish peripheral IV access. We aimed to investigate the feasibilityand safety of EJV cannulation in surgical patients.

METHODS

We performed a retrospective review of EJV cannulation in patients who underwent anesthesia for surgery at a tertiary hospital between 2010 and 2021. We collectedclinical characteristics, including EJV cannulation-related variables, from the anesthetic records. We also investigated the EJV cannulation-related complications, which included anyEJV cannulation-related complications (insertion site swelling, infection, thrombophlebitis,pneumothorax, and arterial cannulation) within 7 days after surgery, from the electronicmedical records during the hospitalization period for surgery.

RESULTS

We analyzed 9,482 cases of 9,062 patients for whom EJV cannulation was performed during anesthesia. The most commonly performed surgery was general surgery(49.6%), followed by urologic surgery (17.5%) and obstetric and gynecologic surgery (15.7%).Unplanned EJV cannulation was performed emergently during surgery for 878 (9.3%) cases.The only EJV cannulation-related complication was swelling at the EJV-cannula insertion site(65 cases, 0.7%). There was only one case of unplanned intensive care unit admission dueto swelling related to EJV cannulation.

CONCLUSIONS

Our study showed the feasibility and safety of EJV cannulation for surgical patients with difficult IV access or those who need additional large-bore IV access during surgery. EJV cannulation can provide safe and reliable IV access with a low risk of major complications in a surgical patient.

Teaching Pediatric Life Support in Limited-Resource Settings: Contextualized Management Guidelines

Of the estimated 6.3 million global annual deaths in children younger than the age of 5 years, nearly all (99%) occur in low- to middle-income countries (LMIC). Existing management guidelines for children with emergency conditions as taught in a variety of current pediatric life support courses are mostly applicable to high-income countries with a different disease range and full resources compared with LMIC. A revised curriculum with evidence-based application to limited-resource settings would expand their potential for reducing pediatric mortality worldwide. This review provides a supplemental curriculum of standards for selected pediatric emergency conditions with attention to the context of disease range and level-specific resources in LMIC. During training sessions, contextualized management guidelines create the framework for realistic and fruitful case simulations.

A prospective evaluation on external jugular vein cut-down approach for TIVAD implantation

Background

Totally implantable venous access devices can be implanted both by percutaneous approaches and by surgical approaches with cephalic vein or external jugular vein cut-down techniques that are related to low intraoperative complication rates. The authors report a prospective evaluation of 83 consecutive external jugular vein cut-down approaches for totally implantable venous access devices implantation.

Methods

Eighty three consecutive patients (28 M, 55 F, mean age 54.2) suffering from solid tumors (58) or hematologic diseases (25) were consecutively submitted to totally implantable venous access devices insertion through external jugular vein cut-down approach (75 on right side, 8 on left side).

Results

All devices were surgically implanted; no instances of intraoperative complications were detected. After a minimum follow-up of 150 days, only one case of wound hematoma and one case of device malfunction due to incorrect catheter angulation were noted.

Postoperative patient satisfaction was evaluated by the use of specific questionnaire that demonstrated a good satisfaction and compliance (92.8 %) of patients with implanted devices.

Conclusions

Despite the lack of controlled studies comparing external jugular vein cut-down approach vs other approaches, this approach should be considered as a tool for long-term central vein catheters positioning, both as an alternative and for primary approach.

External jugular vein approach for TIVAD implantation: first choice or only an alternative? A review of the literature

PURPOSE

Totally implantable venous access devices (TIVADs) can be implanted by percutaneous approach (to the subclavian or internal jugular vein) or by surgical approach, through cephalic vein or external jugular vein (EJV). The authors present a review of the literature about EJV approach for TIVAD implantation.

METHODS

A review of articles indexed in MEDLINE (PubMed) and Cochrane Central Register on "EJV access," "EJV cut-down," and "TIVADs" was performed, even matching the terms.We gathered articles from papers quoting patient number, specialist involved, number of devices implanted, site and technique of implantation and complications.

RESULTS

A total of 1,308 TIVAD implantations through EJV have been reported, with a success rate ranging from 73.7% to 100% and a complication rate up to 13%. Only in 4 on 10 series reported (with more than 15 procedures) the EJV approach was the first choice, while in the other 6 series this approach was the alternative after failure of other approaches.

CONCLUSIONS

Despite the lack of consistent series and prospective studies comparing EJV with other approaches, data present in the literature may support the evidence that EJV approach for TIVAD implantation is safe and effective, and may be considered as the first approach in selected patients.

Monitoring pulmonary artery pressure in children undergoing the Fontan procedure

OBJECTIVE

To compare external and internal jugular venous pressures to monitor pulmonary artery pressure during the Fontan procedure.

BACKGROUND

During the Fontan procedure, the internal jugular vein is used to assess pulmonary artery pressure. The risk of venous thrombosis in the low-pressure Fontan circuit may compromise the long-term success of cavopulmonary anastomosis. This study compared external and internal jugular venous pressures, femoral venous pressure, and actual pulmonary artery pressure during the Fontan procedure.

METHOD

32 children undergoing a single-stage Fontan on cardiopulmonary bypass were monitored for mean external and internal jugular venous pressures and femoral venous pressure pre- and post-cardiopulmonary bypass. Pulmonary artery pressure was also recorded directly after cardiopulmonary bypass. The pressure data were analyzed using analysis of variance, and the coefficient of correlation was found.

RESULTS

The differences between external jugular, internal jugular, and femoral venous pressure pre-cardiopulmonary bypass, and between the 3 venous pressures and the pulmonary artery pressure after cardiopulmonary bypass were found to be non-significant. The coefficient of correlation of external jugular venous pressure and internal jugular venous pressure was 0.8163 (p < 0.0001) pre-cardiopulmonary bypass, and 0.6465 (p = 0.0001) post-cardiopulmonary bypass.

CONCLUSION

The external jugular venous pressure correlates well with both internal jugular venous pressure and femoral venous pressure as a marker of pulmonary artery pressure in children undergoing the Fontan procedure. The use of external jugular venous pressure may also preclude the risk of thrombosis.

Central venous access via external jugular vein with CT-venography using a multidetector helical 16-section CT

OBJECTIVE

To determine the success rate and complications of using the external jugular vein (EJV) for central venous access with a preoperative estimate of the detailed anatomical orientation of the cervical venous plexus using computed tomography venography (CT-V).

DESIGN

Prospective, observational human study.

SETTING

Surgical intensive care unit.

PATIENTS

Fifty-two patients who were undergoing EJV cannulations with CT-V using a Multidetector Helical 16-section CT (MDCT).

INTERVENTION

The preoperative anatomical estimation of the cervical venous plexus was performed with CT-V using an MDCT. In particular, the angulation between the EJV and the right subclavian vein (SCV) was measured. The anatomical abnormalities and the angulation between the EJV and the anterior jugular vein (AJV), transverse cervical vein (TCV), and suprascapular vein (SSV) were estimated.

MEASUREMENTS AND MAIN RESULTS

The success of CT-V was achieved in 52 of 52 patients (100%). The mean angulation between the right EJV and the right SCV was 144 ± 36 degrees in the obtuse-angle cases (88%) and 72 ± 28 degrees in the sharp-angle cases (12%). A plexus of veins under the clavicle was most commonly responsible for insertion of the central venous catheter (CVC). The EJV approach resulted in a 93% rate of successful cannulations. No complications of pneumothorax or carotid artery puncture occurred during insertion procedures.

CONCLUSIONS

The EJV route is associated with comparable technical success and lower major procedural complication. The EJV approach with CT-V guidance is an option as the initial method when central venous cannulation must be performed under suboptimal conditions.

Minimizing complications associated with percutaneous central venous catheter placement in children: recent advances

OBJECTIVES

To summarize existing knowledge regarding the prevalence of complications associated with temporary percutaneous central venous catheters placed in critically ill children, and to review evolving strategies to minimize the prevalence of these complications.

DATA SOURCES

Literature review was performed: PubMed and EBSCOhost were searched using the terms central venous catheter, children, ultrasound, infection, thrombosis, and thromboembolism in various combinations. Citations of interest from identified articles were also reviewed.

STUDY SELECTION

The review focused primarily on pediatric literature relevant to the topic of interest.

DATA EXTRACTION AND SYNTHESIS

Randomized clinical trials and other prospective studies were discussed in greater detail than retrospective, single-center investigations.

CONCLUSIONS

Complications during percutaneous central venous catheter placement in children are not rare and may be in part attributable to abnormalities in vascular anatomy. Thromboses in children with central venous catheters are increasingly recognized as an important problem for which evidence-based preventive measures are lacking. Catheter-associated bloodstream infection rates in critically ill children have markedly decreased over the last decade, associated with an increased emphasis on staff education and the use of insertion and maintenance bundles. Available evidence tends to support the use of two-dimensional ultrasound to augment the landmark technique for catheter placement, but more studies are needed.

Global paediatric advanced life support: improving child survival in limited-resource settings

Nearly all global mortality in children younger than 5 years (99%) occurs in developing countries. The leading causes of mortality in children younger than 5 years worldwide, pneumonia and diarrhoeal illness, account for 1·396 and 0·801 million annual deaths, respectively. Although important advances in prevention are being made, advanced life support management in children in developing countries is often incomplete because of limited resources. Existing advanced life support management guidelines for children in limited-resource settings are mainly empirical, rather than evidence-based, written for the hospital setting, not standardised with a systematic approach to patient assessment and categorisation of illness, and taught in current paediatric advanced life support training courses from the perspective of full-resource settings. In this Review, we focus on extension of higher quality emergency and critical care services to children in developing countries. When integrated into existing primary care programmes, simple inexpensive advanced life support management can improve child survival worldwide.