Jugular Vein In Children Research Articles

Wireless handheld ultrasound for internal jugular vein assessment in pediatric patients.

Rapid evolution of ultrasound technology has allowed widespread use of handheld ultrasound devices (HHUDs) for many possible applications. Along with the adult population, the use of HHUDs for Point of Care Ultrasound (POCUS) in pediatric medicine has been increasing over the last few years. However, pediatric-specific literature is still scarce on mobile vascular ultrasound. To evaluate diagnostic capabilities of Vscan Air™ in comparison with high-end ultrasound for the assessment of the internal jugular vein in children and adolescents. 42 Internal Jugular Veins (IJVs) of 21 pediatric patients were scanned by an experienced examiner using a WLAN-supported handheld ultrasound device (Vscan Air™) and high-end cart-based ultrasound (LOGIQ E9) as reference. B-Mode and Color-coded Doppler (CCDS) were performed and compared. Image quality was assessed using a score of 0 to 5 and statistically analyzed. Results were interpreted independently by two readers in consensus. 21 patients (2-17 years; mean 11,00±4,5 years; female n = 11, male n = 10) were examined. The rating score never dropped below 3 for both devices. The median score evaluation of B-Mode and CCDS for the high-end device was 5.00, of Vscan Air™ 5.00 for B-Mode and 4.00 for CCDS. A significant difference was shown between the two devices in the evaluation of CCDS. Vscan Air™ ultrasound device allows sufficient assessability of the IJV in pediatric patients, opening up new possibilities for fast and mobile POCUS of cervical veins and potential guidance of central venous catheter placement.

Open versus Transcutaneous (Ultrasound-Guided and Based on Anatomic Landmarks) Tunneled Venous Access to the Right Internal Jugular Vein in Children: A Prospective Single-Center Study.

The purpose of this study was to compare the immediate and long-term complications that are associated with the utilized techniques for the insertion of indwelling central venous catheters, that is the open surgical technique, the ultrasound-guided technique, and the transcutaneous technique based on external anatomical landmarks in the right internal jugular vein, to a pediatric population. This was a prospective randomized trial based on a pediatric patient population under 16 years of age of a tertiary pediatric-oncological hospital. The procedure was performed by a medical team with varying experience regarding the percutaneous and open insertion methods. We studied the outcome of our procedure, based on the immediate and delayed complication rate, as well as the needed time in order to complete the procedure and mean duration of line use. The patients that were inserted in our protocol were divided into three subgroups based on the selected technique for the insertion of the central venous catheter. A total number of 88 insertions (25.4%) (out of 346) were based on the technique that was using external anatomical landmarks, 121 insertions were based on the ultrasound-guided transcutaneous technique (34.9%), whereas in 137 cases (39.5%) the open surgical technique was preferred. All cases that were related to catheter re-insertion were excluded from our study. We performed a statistical analysis regarding the catheter dwell time between the three subgroups of patients and no significant difference was recorded. Moreover, the development of thrombosis was investigated, and we noted that a higher percentage of this complication was related to the transcutaneous external landmark and open surgical technique. Also, the incidence of infection was taken into consideration, which manifested an increased incidence when the transcutaneous technique based on external landmarks was used. Ultrasound-guided percutaneous insertion was considered to be a safe and effective technique for the insertion of central venous catheters. Our study also demonstrated a decrease in operating times when performed by operators with increasing expertise, increased preservation of the diameter of the venous lumen, and no increase in complication rates when the ultrasound-guided technique was selected.

A large and complex saccular external jugular vein aneurysm in an adolescent girl

Venous aneurysms of the head and neck region are very uncommon. Aneurysms of the external jugular vein in children are exceedingly rare, and consequently the best approach to diagnosis and management has not been clearly defined. We present the case of a 15-year-old girl with a non-pulsatile, occasionally painful, enlarging fullness in her right supraclavicular fossa and neck. Imaging demonstrated a large and complex right external jugular vein aneurysm with thrombus. Given the symptomatic nature of this aneurysm, recurrent episodes of thrombosis, and the risk of thromboembolism, she underwent surgical excision. Thorough pre-operative planning with additional imaging to better understand the anatomy of this aneurysm was critical to a safe and successful intervention. • External jugular vein aneurysms are rare, especially in pediatric patients. • The best approach to diagnosis and management has not been defined. • Large and complex aneurysms warrant careful preoperative planning. • Additional preoperative imaging may provide information important to a safe intervention.

Simplify long-term venous access via external jugular vein in children

BackgroundBone marrow transfer has begun to be widely used in complicated conditions, such as chemotherapy or hemodialysis, following the description of indwelling central venous catheters and demonstrating their suitability in pediatric patients. The widespread use of it has increased the incidence of complications as well. The use of external jugular vein catheterization, which is a safer route compared to the blind route of administration, has topographical difficulties. The findings obtained in this study showed that these difficulties could be overcome. Our study revealed that the catheterization was possible and described a facilitating technique. Of the pediatric patients involved in the bone marrow transfer programs, patients who were deemed eligible candidates for the use of external jugular vein, based on the preoperative assessment, were included in the present study.ResultsNo early complication was observed in this study. The central catheter was placed on all patients in the same session. Catheters were inserted using the external jugular vein in 98 patients and percutaneous internal jugular vein in 2 patients. A central catheter was inserted through 105 interventions and 103 incisions in 100 patients. External jugular vein use, which was planned before the procedure, was achieved in 98 patients. The internal jugular vein was selected as the second option in 2 patients. The success rate of external jugular vein use was 95.1%.ConclusionsThe findings obtained in this study suggest that placement of a central catheter using an external jugular vein is an appropriate option. Application difficulties can be overcome. Mechanical and early complications are negligible compared to percutaneous blind techniques. The use of the external jugular vein route is easy, requires less equipment, has few complications, and the success of the procedure is a preoperatively predictable technique. External jugular vein catheterization is a better alternative compared to the Seldinger technique, in the absence of ultrasonography, which enhances the success of the percutaneous technique, and in cases where blind techniques, such as bleeding diathesis, may be unfavorable.

Analysis of the therapeutic effect of transesophageal echocardiography-guided percutaneous device closure of atrial septal defects via the right internal jugular vein in children.

Traditional X-ray-guided transcatheter closure of atrial septal defects (ASDs) via the right femoral vein carries a risk of radiation damage, which is greatly exacerbated by age and vascular conditions. Transesophageal echocardiography (TEE) guidance for the closure procedure not only broadens the indications of interventional therapy for ASDs but also avoids radiation exposure. To assess the value of TEE-guided ASD device closure via the right internal jugular vein (RIJV) in children. Nineteen pediatric patients with secondary ASD underwent TEE-guided ASD device closure via the RIJV from July 22, 2015 to July 19, 2017. After the RIJV was successfully accessed, one Fustar curve-adjustable delivery sheath was inserted. The implant depth was adjusted, and the tip of the sheath was curved to facilitate passage through the ASD for the delivery and release of the occluder. TEE was used to guide the entire procedure. In all 19 patients, the ASDs were successfully closed and the occluder was confirmed to have a stable position and good shape, with no residual shunt. During the follow-up period (2months to 2years), no pericardial effusion, thrombosis, tachyarrhythmia, atrioventricular block, or other complications were observed. An adjustable delivery sheath can be used to treat ASD via the RIJV. This procedure has varied indications, and its advantages include a short operation path, procedural accuracy, minimal trauma, and quick recovery, especially for young patients with large ASDs and cases in which a femoral vein approach is difficult. The procedure has great clinical significance and merits attention.

体表ランドマークを用いた穿刺後計測による小児内頚静脈カテーテル留置長の検討

体表ランドマークを用いた穿刺後計測による小児内頚静脈カテーテル留置長の検討

Single-incision technique for placement of tunneled internal jugular vein vascular access in children

Central venous access is indispensable in caring for children with infections, malignancies and chronic illnesses, and image-guided placement of central venous access devices (CVAD) is increasingly used. A single-incision technique for placement of tunneled central venous access devices at the internal jugular vein has been described; however the technique has not been described exclusively in children. To describe our initial experience using the single-incision technique for tunneled central venous access at the internal jugular vein in children. We conducted a retrospective review of the interventional radiology database and electronic medical records of 15 children who received a tunneled central venous access device (CVAD) using a single incision between 2010 and 2012. Patients included eight boys and seven girls with an average age of 11 years (median 13.3 years, range 1-18.7 years) and average weight of 44.2 kg (median 38.3 kg, range 9.6-99.0 kg). A total of 17 primary insertions were performed. Technical success was 100%. Total catheter life consisted of 1,416 catheter-days (mean 83.3 days, range 8-502 days). There were no procedure-related or early complications. Seven late complications requiring intervention occurred in three catheters. Total mechanical and infectious complications occurred at rates of 0.28 and 0.21 per 100 catheter-days, respectively. The adjusted rate for infectious complications was 0.14 per 100 catheter-days. Medical salvage procedures (83%) and interventional radiology salvage procedures (17%) prolonged catheter life by an average of 94.5 days (range 10-329 days). This study demonstrates safe use and technical feasibility of the image-guided single-incision technique for central venous access in children, particularly in children in whom the conventional technique is less desirable.

Appropriate length and position of the central venous catheter insertion via right internal jugular vein in children

Observational study. Tertiary University Hospital. Patients, aged 6 days to 19 years, who underwent contrast enhancement computerized tomography imaging of the thorax (CT-thorax). We measured three lengths consisting of length A in axial plane at the level of the lower border of the 6th C-spine from the skin to RIJV at its mid lumen, length B and C in sagittal plane from the RIJV at the level of the lower of the 6th C-spine to the superior vena cava (SVC) at carina and from carina to SVC-right atrium junction, respectively. Lengths A plus B represented the length of CVC where the tip was expected in the SVC at carina (CVC(carina)). Lengths A plus B and C represented the length of CVC when the tip was expected in the SVC at SVC-right atrium junction (CVC(SVC-RA)). One hundred and sixty-five cases with mean age of 8.1 ± 4.7 years were reviewed. The CVC(SVC-RA) and CVC carina were significantly correlated with age and body surface area (BSA). Using multiple regression analysis, CVC(SVC-RA) (cm) was equal to 6.4 + 2.8[BSA (m2)] + 0.022[age (month)] and CVC(casina) (cm) equal to 4.9 +2.7[BSA (m2)] +0.013[age (month)] (Adjusted R-squared 0.7275, 0.7140). We recommended the appropriate CVC length via RIJV approach should be between these two calculated lengths and the CVC length in each age according to the BSA.

Percutaneous central venous catheterization through the external jugular vein in children: is inserting the guide wire into the superior vena cava essential for successful catheterization?

Background/purposeThe external jugular vein (EJV) is an attractive alternative for percutaneous central venous catheterization (PCVC), with fewer complications. The inability to pass the guide wire into the superior vena cava (SVC) is, however, a major reason for the failure of this approach. The authors report a modification of the Seldinger technique to increase the effectiveness of this procedure in children. MethodsBetween May 2008 and June 2009, we performed 100 PCVCs consecutively in children using the Seldinger technique through the EJV (Step 1). In cases in which the guide wire could not be passed into the SVC, the guide wire was kept in the EJV; and only the catheter was introduced into the central venous position (Step 2). Differences between the standard and modified Seldinger techniques were analyzed. ResultsThe procedure with the standard Seldinger technique (Step 1) was successful in 13 (13%) out of 100 patients. In 84 (96.5%) of the 87 remaining patients, PCVC was achieved with the modified Seldinger technique, without the insertion of the guide wire until the SVC (Step 2). Altogether, 97 catheters (97%) were successfully inserted, with 85 (87.6%) correctly positioned in the SVC. In addition, there were 7 (7%) clinically irrelevant hematomas during catheterization. ConclusionsThe EJV is an excellent alternative anatomical location for the completion of PCVC in children. Placing the guide wire in a central position is not essential to the success rate of this approach. The proposed modified Seldinger technique allowed PCVC to be performed through the EJV safely and with a high success rate in children and adolescents.

Percutaneous central venous catheterization through the external jugular vein in children: improved success rate with body maneuvers and fluoroscopy assistance

Background/Purpose Central venous catheterization is among the most common procedures performed by pediatric surgeons. Significant morbidity and even mortality can ensue from the widespread approach to the deep veins of the neck and femoral region. The external jugular vein (EJV) is a low-morbidity alternative for percutaneous catheterization in children, but it has yielded a low success rate in previous reports .The authors show an improved success rate with this option. Methods We performed an analysis of 33 patients' charts in which central venous catheterization using Seldinger technique through the EJV was attempted in 2005. Age, diagnosis, maneuvers used for success, fluoroscopy usefulness, and types of inserted catheters were evaluated. Results The procedure was successful in 26 (78.8%) patients without complications. Diagnosis was neoplasia in almost half of the patients (42%). In half of the successful cases, body maneuvers were used, namely, twisting the head of the patient to the side of the vein and stretching the ipsilateral arm and shoulder. All but one procedure were completed under fluoroscopic guidance. In 6 (23%) patients, a long-term catheter was inserted. Conclusions The EJV is an excellent option for central venous catheterization in children. The execution of simple maneuvers along with fluoroscopic assistance might allow for an improved success rate not only for short-term but also for long-term catheter insertion.

Central venous access through the external jugular vein in children submitted to bone marrow transplantation

Establishment of long-term central venous access is a sine qua non step for bone marrow transplantation in children. Most frequently, long-term central venous access has been obtained via blind percutaneous cannulation of subclavian and internal jugular veins or via internal jugular vein cutdown. In order to avoid some potential minor and major complications associated with the subclavian or internal jugular approaches, the authors describe an easy, simple and safe method for central venous access through an external jugular vein cutdown that should be of interest to readers involved in the field of bone marrow transplantation. It should be also considered for children as well as adults needing central venous access via an external catheter - or totally implantable port - for reasons other than bone marrow transplantation, such as total parenteral nutrition and administration of chemotherapeutic agents.

Right internal jugular vein venography in infants and children.

We obtained venograms of the right internal jugular vein (RIJV) in 105 infants and children with congenital heart disease during cardiac catheterization. No major anomalies were found in the course of the RIJV. The diameter of the RIJV tended to increase with the patient's age, weight, and height. However, some disproportionately small vessels were seen in 8% of the patients. The depth from the skin to the RIJV varied from 2.5 to 20 mm and did not significantly correlate with age, weight, or height. Confirmation of the diameter or the depth of the RIJV by venography may facilitate clinical decisions and may be useful for performing percutaneous cannulation. We obtained venograms of the right internal jugular vein in children with congenital heart disease. Generally, the diameter increased with the patient's body size, but disproportionately small vessels were seen in 8% of the patients. Preoperative internal jugular venography may facilitate identifying those patients.

Internal jugular phlebectasia in children

Phlebectasia is an abnormal dilatation of an isolated vein, may affect any vein, and is usually asymptomatic. When the internal jugular vein is involved, it presents as a cervical swelling that can mimic the signs of either pharyngocele or a laryngocele and, because of its rarity, is frequently misdiagnosed. We describe 2 cases of phlebectasia of internal jugular vein in children with voice change in one of them. No treatment is necessary for this benign, self-limiting condition. Clinical features, diagnosis, treatment options, and a review of the literature about this rare venous lesion are presented.

Position of the internal jugular vein in children. A study of the anatomy using ultrasonography.

The relative anatomy of the internal jugular vein (IJV) was studied in 25 patients undergoing cardiac catheterization under general anaesthesia, with the use of a portable ultrasound probe. In 14 of cases the IJV was anterior, 1 anterolateral and in 10 lateral to the carotid artery between the two heads of the sternocleidomastoid muscle. At the level of the cricoid cartilage, in six cases the IJV was anterior, three anterolateral and in 16 of children the IJV was lateral to the carotid artery. When attempting to cannulate the IJV, because of the variability in relationship of the IJV to CA the technique used should be modified depending upon the level at which cannulation is attempted. The position of the IJV in the child appears to be so variable extra care should be taken when cannulating the IJV and it should not be assumed that the techniques used in adults are directly transferable.

A safe approach to percutaneous cannulation of the internal jugular vein in children.

The internal jugular vein (LTV) can provide an extremely reliable site for correct placement of central venous catheter. The average success rate using this approach is more than 95 percent l. However, percutaneous cannulation of the IJV has not been recommended in pediatric age group because of the low success rate in children under age 2 • Monitoring of central venous pressure (CVP) is quite useful in the management of children undergoing major surgery, so that a safe and sure approach to percutaneous cannulation is mandatory. We describe an improved technique for the .percutaneous IJV cannulation which, in our experience, has proven very reliable when attempting to identify the IJV.

Percutaneous catheterization of the internal jugular vein in infants and children

Two methods are described for percutaneous catheterization of the internal jugular vein in children. The technique can be used even in premature babies. No serious complications were observed from the catherization in 100 cases.