Feasibility of Wire-in-Needle Technique for Ultrasound-Guided Central Venous Catheter Insertion in a Pediatric ICU.

Ahmad Jorya,Ali Al Shehri,Mohammed Naeem

doi:10.7759/cureus.22211

Abstract

ObjectiveFor further evaluating the feasibility and safety of wire-in-needle (WIN) technique application for ultrasound-guided central venous catheter (USG-CVC) insertion in a pediatric intensive care unit (PICU).MethodsWe prospectively monitored all patients who underwent central line insertion guided by ultrasound from March 2018 to March 2019. An independent nurse recorded the patient's age, gender, weight and BMI, diagnosis, indication for insertion, blood pressure state, insertion time, line size, number of pricks, and arterial punctures.ResultsA central line was inserted in 141 patients. The author applied the WIN technique in 16 patients, while in 125 patients, the central line was inserted via the traditional technique. The success rate was 100% for the WIN technique arm with zero arterial pricks, and the mean number of needle pricks was 1.1. For the traditional technique arm, the success rate was 90% with three arterial pricks. The mean number of needle pricks was 1.38. The insertion time was 86.25 seconds and 304 seconds for the WIN technique and the standard technique, respectively; this difference was statistically significant (p <0.001).ConclusionThe WIN technique is feasible and could provide a safe and relatively fast alternative technique for real-time USG-CVC insertion in the PICU. The WIN technique is feasible and not inferior to the standard short-axis technique. A good level of experience related to USG-CVC insertion provides a safe and rapid alternative technique for real-time USG-CVC insertion in the PICU.

Highlights

Ultrasound-guided central venous catheter (USG-CVC) insertion is a ubiquitous pediatric intensive care unit (PICU) procedure and has received considerable critical attention in recent years
The author applied the WIN technique in 16 patients, while in 125 patients, the central line was inserted via the traditional technique
This paper aims to evaluate the feasibility of the WIN technique application for sick children admitted to a PICU and compare its efficacy with the standard technique traditionally used for USG-CVC insertion

Summary

Introduction

Ultrasound-guided central venous catheter (USG-CVC) insertion is a ubiquitous pediatric intensive care unit (PICU) procedure and has received considerable critical attention in recent years. Compared with landmark (LM)-guided techniques, ultrasound use is considered a significant contributing factor to improved CVC insertion success rates, decreased number of cannulation attempts, and reduced incidence of CVC insertionrelated complications. The American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists recommend that, whenever possible, trained clinicians should use real-time ultrasound during CVC insertion of the internal jugular (IJ) and the femoral vein. This confirms the vascular access and guarantees that the guidewire is absent in the adjacent structures. When the short-axis view (SAX) is used solely, extra measurements are recommended to confirm CVC placement, such as manometry with a fluid-filled catheter or transesophageal echocardiographic or fluoroscopic imaging [3]

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Discussion

Conclusion