Ultrasound evaluation of techniques for internal jugular vein puncture in children

Sérgio Tomaz Schettini,Luiz Fernando Ybarra Martins De Oliveira,Harold Ruiz Henao,Henrique Manoel Lederman

doi:10.1590/s0102-86502008000500014

Sérgio Tomaz Schettini, Luiz Fernando Ybarra Martins De Oliveira + Show 2 more

Open Access

https://doi.org/10.1590/s0102-86502008000500014

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Abstract

To determine by ultrasound which access and position the child must stay to obtain the best transversal section of the right Internal Jugular Vein (RIJV) allowing a safer puncture. Three possible accesses to the RIJV, anterior, lateral and posterior, from 57 healthy children, were analyzed through ultrasound images in a sequence of positions of the head, in supine position, with or without a roll under the scapula: head centered in neutral position with and without a roll (NPP and NP); contra lateral rotation with and without a roll (CLRP and CLR), neutral position and the patient raised in 30 degrees in Trendelenburg position (TDG). To analyze the results it was applied one statistic method, with variation analysis to the same individuals. Ultrasound evaluation in each one of the proposed positions. The statistical analysis of the results observed that the lateral puncture with the patient in the neutral position, in Trendelemburg without a roll, offers a bigger area in comparison to all the other options of puncture and positioning of the patient (p<0, 0001). The safer way for the puncture of RIJV in children is obtained in neutral position in Trendelemburg by lateral puncture, without a shoulder roll.

Highlights

The catheterization of the internal jugular vein (IJV) is a procedure usually done in children and applied at the most clinical conditions with the usage of a simple technique
The success rate in the catheterization of IJV is lower and the number of complications is higher in children than among adults due to the smaller size of the vein, the close proximity of the common carotid artery and the variation of the vein position related to the artery and to the cervical muscles not fully developed, which makes difficult the characterization of anatomical landmarks in order to due a precise puncture
The sequence of examination was: 1) Supine position with the head in neutral position without the use of a roll under the scapula (NP); 2) Supine position with contra lateral rotation of the head without the use of a roll under the scapula (CLR); 3) Supine position with the head in neutral position with the use of a roll under the scapula (NPP); 4) Supine position with contra lateral rotation of the head with the use of a roll under the scapula (CLRP); 5) Supine position with the head in the neutral position with the patient in Trendelenburg without the use of a roll under the scapula (TDG)

Summary

Introduction

The catheterization of the internal jugular vein (IJV) is a procedure usually done in children and applied at the most clinical conditions with the usage of a simple technique. The possible complications of the IJV puncture are: accidental puncture of the common carotid artery (4-10%)[1] puncture of the nerves, of the main lymphatic duct in the left hemithorax, Ultrasound evaluation of techniques for internal jugular vein puncture in children malposition of the catheter with hydrothorax, hemothorax, venous thrombosis, pseudo aneurysm, arteriovenous fistula. The incidence of these complications are directly related to the skill and the physician’s experience whereas the incapacity of obtaining the catheterization of IJV through puncture is referred in 19, 4%2. We must consider the lack of cooperation from the small patients, and the risks related to their sedation

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