Ultrasound-guided infraclavicular axillary vein cannulation: - is it a good alternative to internal jugular vein in pediatric cardiac surgery?

Abstract

INTRODUCTION: This study was designed to compare the rate of successful first attempt and mechanical complications between internal jugular vein (IJV) and axillary vein (AXV) cannulation. METHODS: This prospective, randomized, comparative, controlled study included 220 pediatric patients with age range 1 to 12 years admitted for cardiac surgery. Patients were allocated into 2 equal groups, IJV group and AXV group. The main collected data were the rate of successful first, second and third punctures attempts and the rate of mechanical complications (arterial puncture, pneumothorax, catheter occlusion, catheter malposition, nerve injury). RESULTS: There was no statistically significant difference (P=0.053) in the first skin puncture success rate in both groups (AXV group 80% and IJV group 68%). There were no significant differences as regard the second and third skin punctures success rates. The incidence of failed vein puncture was similar (P=1.000) in IJV (3%) and AXV (2%) groups. The vein puncture and catheter insertion times were comparable in both groups. The rates of arterial puncture, pneumothorax and catheter malposition were similar in IJV and AXV groups (12% vs 11%, 4% vs 1%, 3% vs 5% respectively). Catheter occlusion with sternal retraction was significantly higher (p=0.029) in AXV than IJV group (6% vs 0%). No patient developed postoperative phrenic (IJV group) or brachial plexus nerve injury (AXV group). DISCUSSION AND CONCLUSION: Ultrasound-guided cannulation of both infraclavicular AXV and IJV were similarly associated with high success rate and low incidence of mechanical complications.