Ultrasound-guided thin-wall needle technique versus cannula-over-needle technique in internal jugular vein catheterization in infants

Abstract

Background Internal jugular vein (IJV) is the most common site for central venous catheter (CVC) insertion in pediatric cardiac surgery, with a lower success rate than adults. Two techniques are used, the thin-wall introducer needle (TWN) technique (Seldinger) or cannula-over-needle (CON) technique (modified Seldinger). Purpose To compare between TWN and CON techniques for the insertion of IJV CVC in infants in terms of success, number of attempts, catheter insertion time, and complications. Patients and methods One hundred and twenty infants admitted for elective cardiac surgery randomly assigned into either TWN group or CON group (60 patients each). CVC insertion was performed on the right IJV under ultrasound (US) guidance. Demographic data were recorded and infants subcategorized according to their age to less than 30 days, 2–6 months, and 7–12 months. The success rate, first attempt success, number of attempts, duration of each attempt, access time, cannulation time, and complications as assessed by US were recorded and subjected to statistical analysis. Results There were significantly higher first trial success in CON than TWN in age subgroups of less than 30 days (75 vs. 22.2%) and 2–6 months (76.5% vs. 40%) and significantly higher overall success rate in CON in the age subgroup of less than 30 days (91.7 vs. 44.4%). Significantly lower number of attempts in CON in age subgroups of less than 30 days (mean, 1.75 vs. 4.77) and 2–6 months (mean, 1.24 vs. 1.73) with significant reduction in venous hematoma were detected by US. No significant difference in cannulation time between the two techniques in any of the subgroups. Conclusion In the age group of less than 30 days, CON had higher first trial success, overall success, lower number of attempts, and lower complication rate than TWN. In the age group of 2–6 months, CON had higher first trial success, lower number of attempts, and lower complication rate than TWN. In age the group of 7–12 months, TWN offered an advantage over CON with shorter access time and duration of attempt with no other significant difference.