Anatomical analysis of Sedillot's triangle as a reliable landmark for insertion of central venous catheters in neonates using a central approach

Abstract

IntroductionSurgeons employ central venous catheterization as a therapeutic or preventive measure in the pediatric population. These catheters are introduced into the internal jugular, subclavian, or femoral veins using the central approach, involving the insertion of the needle into the apex of Sedillot's triangle, a well-defined anatomical reference point. Using a neonatal sample, this study ascertained the precise positioning of the internal jugular vein to evaluate its suitability as a central venous catheter insertion site. We also determined the location of the vein in relation to Sedillot's triangle. Materials and methodsNineteen formalin-fixed neonatal cadavers, encompassing both the left and right sides of the neck region (totaling 38 sides), were dissected to expose the underlying soft tissues and neurovascular structures. Thereafter, the three boundaries of Sedillot's triangle were identified, demarcated, and measured. The internal jugular vein's position within Sedillot's triangle was meticulously recorded, and the diameter of the vein was measured. ResultsAmong the 38 sides examined, only three exhibited fully formed triangles, with most of the samples featuring a groove instead. When the needle was placed at the apex of Sedillot's triangle (or within the groove), the needle consistently accessed the internal jugular vein only 65.8% of the time. In 23.7% of cases, the apex was observed lateral to the internal jugular vein, and in 10.5% of cases, the apex was positioned medially. ConclusionThe apex of Sedillot's triangle is an unreliable anatomical landmark for the insertion of central venous catheters in neonates. Caution should be exercised when employing this landmark in the absence of ultrasound guidance.