Vein Cannulation In Children Research Articles

Comparison of the Ultrasound-Guided Supraclavicular and Infraclavicular Approaches for Subclavian Vein Cannulation in Children With Congenital Heart Disease

Objective(s)Central venous catheterization (CVC) is widely used in pediatric critical patients. We thought to compare the success rate and safety of ultrasound-guided subclavian vein cannulation performed via infraclavicular and supraclavicular approaches. DesignWe compared the success rate of the first puncture and other information for cannulation in the children with congenital heart disease (CHD) requiring central venous catheterization who were randomly assigned to the supraclavicular approach group (Group A) or infraclavicular approach group (Group B). SettingMedical university hospital pediatric cardiac intensive care units (CICUs). ParticipantsPediatric patients diagnosed with CHD in the preoperative period who were admitted to the CICU and required subclavian vein catheterization. InterventionsUltrasound-guided subclavian vein cannulation. Measurements & Main ResultsSixty-seven children were included in the study, with 32 in Group A and 35 in Group B. Notably, there was a significant difference in the success rate of the first puncture between Groups A and B (90.6% vs. 71.4, %, p = 0.047). Furthermore, the access time in Group A was 11.8 (3.2–95) seconds, which was significantly shorter than that in Group B (16.0 [6.5–227] seconds, p = 0.001). In addition, the catheter malposition rate in Group A was significantly lower than that in Group B (0% vs. 11.4%, p = 0.049). Conversely, there were no significant differences in the total access time, overall success rate, and complications (e.g., pneumothorax, hemorrhage, puncture artery, and nerve injury) between the two groups. ConclusionsFor children with congenital heart disease requiring central venous catheterization during the perioperative period, the subclavian vein is a feasible site for catheterization. The supraclavicular approach, especially the left side, has a higher first-puncture success rate, shorter access time, lower complications, and the trend of lower incidence of catheter malposition. However, a larger sample size of randomized controlled study is expected to verify the advantages of ultrasound-guided subclavian catheterization in children.

Real-time ultrasound-guided axillary vein cannulation in children: a randomised controlled trial.

The axillary vein is a good site for ultrasound-guided central venous cannulation in terms of infection rate, patient comfort and its anatomical relationship with the clavicle and lungs. We compared real-time ultrasound-guided axillary vein cannulation with conventional infraclavicular landmark-guided subclavian vein cannulation in children. A total of 132 paediatric patients were randomly allocated to either ultrasound-guided axillary vein (axillary group) or landmark-guided subclavian vein (landmark group). The outcomes measured were success rate after two attempts, first-attempt success rate, time to cannulation and complication rate. The success rate after two attempts was 83% in the axillary group compared with 63% in the landmark group (odds ratio 2.85, 95%CI 1.25-6.48, p=0.010). The first-attempt success rate was 46% for the axillary group and 40% for the landmark group (p=0.274) and median time to cannulation was 156s for the axillary group and 180s for the landmark group (p=0.286). There were no differences in complication rates between the two groups, although three episodes of subclavian artery puncture occurred in the landmark group (p=0.08). We conclude that axillary vein cannulation using a real-time ultrasound-guided in-plane technique is useful and effective in paediatric patients.

Supraclavicular Approach to Ultrasound-Guided Brachiocephalic Vein Cannulation in Children and Neonates.

The correct choice of intra vascular access in critically ill neonates should be individualized depending on the type and duration of therapy, gestational and chronological age, weight and/or size, diagnosis, clinical status, and venous system patency. Accordingly, there is an ongoing demand for optimization of catheterization. Recently, the use of ultrasound (US)-guided cannulation of the subclavian vein (SCV) has been described in children and neonates. This article gives an overview of the current use of US for achieving central venous catheter placement in the SCV or the brachiocephalic vein (BCV) in neonates. More than 1,250 catheters have been reported inserted in children and neonates for a cumulated success rate of 98.4% and the complication rate is reported to be low. The technical aspects of various approaches are discussed, and we offer our recommendation of an US-guided technique for SCV and BCV cannulation based on our experience in a large NICU setting. Although the cannulation the SCV or BCV does not substitute the use of peripherally inserted central catheters or umbilical venous central catheters in neonates, it is a feasible route in very small children who are in need of a large caliber central venous access.

Effectiveness and complications of ultrasound-guided subclavian vein cannulation in children and neonates

BackgroundThe ultrasound (US)-guided supraclavicular approach to subclavian vein (Sup-SCV) catheterisation in children has recently been described and evaluated in a small cohort. The aim of this study was to assess this technique in a large paediatric cohort including neonates. MethodsWe conducted a prospective observational study between November 2010 and December 2013 which included 615 children divided into two groups according to their weight: Group 1≤5kg (n=124), Group 2>5kg (n=491). All procedures were performed under general anaesthesia by an anaesthesiologist or a supervised resident. The success rates of catheter insertion, the number of punctures required, the procedure time, and the complication rates were analysed. ResultsSup-SCV catheterisation was successful in 98% of the cases and was higher in Group 2 than in Group 1 (99.4% versus 92.7%, P<0.001). The success rate after the first attempt was higher and the incidence of multiple attempts (≥3 punctures) was lower in Group 2 than in Group 1 (84.2% versus 64.5%, P<0.001 and 4.5% versus 19.4%, P<0.001). The success rate was similar between right and left cannulations (P=0.404), and according to physician experience (P=1.000). Procedure time was fast in both groups with a median time for all procedures of 40 seconds [30–90]. Among the procedures recorded, only five arterial punctures and no cases of pneumothorax were observed. ConclusionUS-guided Sup-SCV catheterisation appears to be fast and safe in children and neonates, even if it remains a little more difficult to achieve in lower-weight patients.

Ultrasound–Guided Left Brachiocephalic Vein Cannulation in Children With Underlying Bleeding Disorders

To evaluate the safety and effectiveness of ultrasound-guided left brachiocephalic vein cannulation in infants and children with underlying bleeding conditions. Retrospective cohort. PICU of a tertiary pediatric hospital. Thirty-four patients requiring central venous catheterization from January 2011 to January 2012. None. Two pediatric intensivists, experienced in ultrasound-guided vessel cannulation, performed the ultrasound catheterization of the left brachiocephalic vein. Ultrasound equipment consisted of a standard ultrasound monitor with a linear 6-13 MHz probe. The ultrasound monitor was set on a resolution with a depth of 1.8 cm for infants and 2.2 cm for children. The "in-plane" technique was used for all patients. Thirty-four catheterizations were performed. Patient median age was 12.5 months (5.75-63.5 mo) and median weight was 9.25 kg (7-16.25 kg). The population of infants and children analyzed was composed of 25 patients with hematologic disorder (73%) treated with hematopoietic stem cell transplantation, five patients (15%) supported with extracorporeal membrane oxygenation for viral pneumonias, and four patients (12%) with uremic hemolytic syndrome. A 4F catheter was used in 79% of cases. Left brachiocephalic vein cannulation was successful in all 34 patients. Median time needed for cannulation was 350 seconds (277.5-450 s). The overall complication rate was 9% (3 of 34) and consisted of difficulty in advancing the guidewire after having pierced the vein. The time required for catheter positioning and complications was not associated with both lower body weight and body surface area of the patients (p > 0.05). Mean central venous catheter duration was 32 ± 4 days. Data reported in this retrospective study confirm the safety and effectiveness of ultrasound-guided left brachiocephalic vein catheterization in infants and children with underlying bleeding disorders.

Ultrasound guidance versus the landmark technique for subclavian vein cannulation in children

Ultrasound guidance versus the landmark technique for subclavian vein cannulation in children