Ultrasound guided central venous cannulation in infants and children presenting for cardiac surgery

Abstract

Recent guidelines propose the use of ultrasound assisted central venous cannulation in all cases [1]. Traditional landmark techniques have a success rate of 96%. Complication rates range from 0.3% to 12% according to the experience of the physician and the definition of complications [2]. Our aim was to assess whether ultrasound guidance for central venous cannulation may assist consultant paediatric cardiac anaesthetists, saving time and reducing complication and failure rates in infants and children presenting for cardiac surgery. Approval from our Local Research Ethics Committee was obtained. Patients were randomised into either the landmark technique or the ultrasound groups. Only consultant cardiac anaesthetists performed the cannulations. A Baird site rite II ultrasound machine was used. Time to insertion of a guide wire into the right internal jugular vein was measured. Complications and failures were documented. One hundred and thirty-four patients were recruited, 65 into the landmark group and 69 into the ultrasound group. The ultrasound device was unavailable in 10 patients randomised into the ultrasound group; these patients were excluded from further analysis. The landmark group had 52 successes (80%), six complications (9%: three haematomas and three carotid punctures) and seven failures to cannulate (11%). The ultrasound group had 30 successes (51%), 14 complications (24%: seven haematomas and seven carotid punctures) and 15 failures (25%). Ultrasound guidance did not reduce the time taken to insert a guide wire into the right internal jugular vein, but increased the incidence of failures and complications when used by this group of paediatric cardiac anaesthetists. In different patients, in different settings and with different physicians, the risks of complications or failure of central venous catheterisation vary substantially. Guidelines should concentrate on identifying factors that may predispose to difficulties or complications and encourage the use of ultrasound guidance in those patients or with that particular group of physicians [3].