Venous Cannulation In Infants Research Articles

Comparison between in-plane and out-of-plane techniques for ultrasound guided cannulation of the left brachiocephalic vein in pediatric population: A randomised controlled trial

Background and aimsBrachiocephalic vein is a novel site for central venous cannulation in infants. It becomes useful in patients where the internal jugular vein lumen is small (e.g., volume deficient patient), patients with a history of multiple cannulations, and in whom subclavian puncture is contraindicated. MethodsIn this randomized double-blinded study, 100 patients, aged between 0 and 1 year scheduled for elective central venous cannulation were recruited. The patients were allocated into two groups (50 patients in each). Group I patients had ultrasound (US) guided cannulation of the left brachiocephalic vein (BCV) by inserting a needle in-plane to the US probe from lateral to the medial direction, whereas Group II patients underwent cannulation of the BCV via an out-of-plane approach. ResultsThe first-attempt success rate was significantly higher in Group I (74%) than in Group II (36%) (p < 0.001). The total success rate was higher in group I (98%) than in group II (88%) however the difference was statistically insignificant (p > 0.05). The mean BCV cannulation time was significantly shorter in group I (35.46 ± 25.10) than in group II (65.24 ± 40.26) (p < 0.001). The rate of unsuccessful BCV cannulation (12%) and hematoma development (12%) was significantly higher in group II than in group I (2%). ConclusionCompared to the out-of-plane approach of left BCV cannulation, US-guided in-plane cannulation of the left BCV increased the first-attempt success rate, decreased the number of puncture attempts, and decreased the time required for cannulation.

Light-emitting Diode Vein Finding Device in Facilitating Peripheral Intravenous Cannulation in Children: A Randomised Clinical Study

Introduction: Peripheral venous cannulation in the paediatric age group is always a challenging task. The transillumination technique improves the visualization of veins. The Light Emitting Diode (LED) vein finder device is based on the side transillumination principle. Aim: To evaluate the role of transilluminating LED vein finder device (Optramed Vein-Lite), for peripheral intravenous cannulation in children with respect to ease of cannulation, time taken and number of attempts. Materials and Methods: This randomised clinical study was conducted in Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, from January 2018 to January 2020. Total 130 patients, age &lt;3 years, of either sex, and scheduled for surgery under general anaesthesia were included in the study. They were randomised into two groups. Group I (n=65) where venous cannulation was done using a transilluminating LED vein finder device, and group II (n=65) where venous cannulation was done after visualising and palpating the vein manually (conventional technique). Both the groups were compared with respect to the Difficult intravenous access (DIVA) score, number of attempts, ease of intravenous cannulation (cannulation on first or second attempt as ‘easy’, more than two attempts as ‘difficult’ cannulation) and time required for intravenous cannulation. The qualitative variables were expressed as frequencies/percentages and compared using the Chi-square test. A p-value &lt;0.05 was considered statistically significant. Results: The mean age of the population in group I was 17±13 months, and in group II was 15±23 months (p-value=0.5427). There was a significant variation with respect to the number of attempts; the first attempt success was 90.7% in group I vs 63% in group II (p-value= 0.0014). In group I, cannulation was easy in 95% of patients while in group II only 76.9% of patients had easy cannulation (p-value=0.0018). Time taken for intravenous cannulation in group I was 19.385±6.2015 sec and in group II was 22.886±11.6716 sec (p-value=0.0346). Conclusion: Transillumination is a useful technique to improve the success rate of peripheral venous cannulation in infants and children.

The Clavicular Notch as an Alternate Anatomical Landmark for Internal Jugular Vein Cannulation in Infants and Children: A Descriptive Study

Objective: To evaluate an alternate anatomical landmark technique for internal jugular vein cannulation in infants and children. Aim: To evaluate the success and safety of the clavicular notch as a bony landmark for central venous cannulation in infants and children. Background: Central venous cannulation can be particularly difficult in infants and children. While ultrasound-guided techniques are well established, the majority of central venous catheters are placed using landmark guidance with variable success rate. This prospective study documents the success and safety of a modified landmark technique using the clavicular notch as a bony landmark for central venous cannulation in this group of patients. Materials and methods: One hundred and fifty children under 12 years of age belonging to ASA grade I to III were included in the study. All children were placed in 150 trendelenberg position with head rotated 40o to the opposite side. The relationship of the IJV to the carotid artery was noted by audio Doppler. The notch technique was used only if the IJV was detected by Doppler at the notch. Using the standard seldinger technique the IJV was cannulated and the complications were noted. The traditional approach was our rescue method. Results: The IJV was localized at the clavicular notch in 95.33% (143/150) cases by audio Doppler and the overall successful cannulation rate was 98.6% (141/143). We encountered complications in 13 (8.6%) cases, none of which had any adverse outcome. Conclusion: This study confirms the consistent location of IJV at the clavicular notch. Therefore, the ‘Notch technique’ can be used successfully for IJV cannulation in infants and children.

Ultrasound-Guided Central Venous Cannulation in Infants Weighing Less than 5 Kilograms

Recent reports suggest that ultrasound-guided central venous cannulation may also be safe and effective in infants. This study aimed to evaluate the success and complications rate of this technique in infants weighing less than 5 kg. We studied 45 infants, weighing less than 5 kg (mean weight: 2.9 ± 1.1 kg, median: 3.1) needing a central venous access for intensive care treatment. In all patients, venous access was obtained by ultrasound-guided cannulation of the internal jugular vein (IJV). Central venous cannulation was successful in all 45 infants. The right internal jugular vein (IJV) was used in most cases (92%). The IJV was antero-lateral to the carotid artery in 66% of patients, lateral in 28% and anterior in 6%. Although we recorded 10 complications (22.2%), only one was clinically relevant (one pneumothorax). The other complications were repeated venipunctures (n=4), kinking of the guidewire (n=3) and local venous hematomas (n=2). The time required for completing the procedure was 7 ± 4.3 min, while the mean time of central venous catheter permanence was 5.5 ± 8 days. There was a negative correlation between the patient's weight and the time needed for cannulation (p<0.01). Complications occurred in infants with a lower body weight (p<0.01). Our experience suggests that ultrasound-guided central vein cannulation can be performed by well-trained physicians in infants weighing less than 5 kg without relevant risks.

A randomized study of a new landmark‐guided vs traditional para‐carotid approach in internal jugular venous cannulation in infants

Central venous catheterization is more difficult in infants than in adults. Ultrasound-guided internal jugular venous cannulation may improve the accuracy of localization of the internal jugular vein (IJV), but ultrasound equipment is not universally available. The landmark technique remains essential in daily practice. One hundred and forty infants, aged 3-12 months, who were scheduled to undergo surgery for congenital heart disease, were randomly assigned to a new landmark-guided group or traditional para-carotid group. In the new landmark-guided group, at the level of the cricoid cartilage, the carotid artery was marked, and the apex of the triangle formed by the two heads of the sternocleidomastoid muscle and the clavicle was also marked. The needle was inserted at the midpoint of the two marked points and advanced in the direction of the ipsilateral nipple. Seven cardiac anesthesia fellows participated in this study, and each fellow performed 10 central catheterizations in each group. The times to successful catheterization of the IJV were measured. Attempts at needle punctures for successful catheterization and procedural complications were counted. The IJV was successfully punctured within three attempts in 74% of infants in the para-carotid group, compared with 94% in the new landmark-guided group (P = 0.001). The time to successful catheterization was significantly shorter in the new landmark-guided group (P < 0.01). The incidence of arterial punctures in the para-carotid group was 11%, compared with 3% in the new landmark-guided group (P < 0.05). Compared with traditional para-carotid approach, the new landmark-guided approach for access of the IJV during teaching central catheterization significantly reduced carotid arterial puncture, provided a higher success rate and minimized procedure time in infants aged 3-12 months.

Ultrasound-guided subclavian vein cannulation in infants and children: a novel approach

Central venous cannulation in infants remains challenging even for experienced paediatric anaesthesiologists. Ultrasound (US)-guidance techniques are proven to be safer for internal jugular vein catheterization. But the subclavian vein (SCV) is often the preferred site for long-term central venous catheterization in children. We describe a novel US-guided approach for SCV cannulation in infants and children. The principle of this technique is to place the US probe at the supraclavicular level to obtain a longitudinal view of the SCV, and to gain access to the vein via the usual infraclavicular route to cannulate it under ultrasonic control. Details and pitfalls of this technique are described. The prospectively collected results of our first 25 punctures are reported. Patients' weight and age range were 2.2-27 kg and 1 day to 9 yr, respectively: 76% of the children weighed less than 10 kg. The success rate at the first attempt was 84% and 100% after two attempts. An asymptomatic thrombus in the SCV could also be detected with this technique. This US-guided approach of the SCV offers a new possibility for central venous catheterization in children. This technique seems promising for children less than 10 kg and probably also for older children. It provides good quality needle guidance and allows to check the vessel patency before puncture.

The use of transillumination for peripheral venous access in paediatric anaesthesia

The use of transillumination for peripheral venous access in paediatric anaesthesia

Clinical review: Vascular access for fluid infusion in children

The current literature on venous access in infants and children for acute intravascular access in the routine situation and in emergency or intensive care settings is reviewed. The various techniques for facilitating venous cannulation, such as application of local warmth, transillumination techniques and epidermal nitroglycerine, are described. Preferred sites for central venous access in infants and children are the external and internal jugular veins, the subclavian and axillary veins, and the femoral vein. The femoral venous cannulation appears to be the most safe and reliable technique in children of all ages, with a high success and low complication rates. Evidence from the reviewed literature strongly supports the use of real-time ultrasound techniques for venous cannulation in infants and children. Additionally, in emergency situations the intraosseous access has almost completly replaced saphenous cutdown procedures in children and has decreased the need for immediate central venous access.

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

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].

Teaching successful central venous cannulation in infants and children: Audio doppler versus anatomic landmarks

Objective: To determine if vein localization with an audio Doppler increases successful central venous cannulation and decreases complications in infants and children when performed by inexperienced operators, compared with vein localization by anatomic landmarks (ALs). Design: A prospective cohort of infants and children undergoing central venous cannulation for cardiac surgery. Setting: A university-affiliated children's hospital with a pediatric anesthesia fellowship program. Participants: All infants and children undergoing cardiac surgery between July 1, 1996, and January 1, 1997. Interventions: Subjects had central venous catheters (CVCs) placed by an anesthesia fellow by either ALs or audio-Doppler localization of the veins. Measurements and Main Results: Eighty-four children were studied. Internal jugular vein (IJV) cannulation was attempted in 71 (85%) children and femoral vein cannulation in 13 (15%) children. Time to catheter insertion, number of needle passes, and artery puncture were noted. Sixty-one of 63 (97%) children had successful central venous cannulation by an anesthesia fellow using audio-Doppler vein localization. This was significantly greater than the 13 of 21 (62%) successful cannulations among children who had veins localized by ALs. Time to insertion did not differ by method of vein localization; however, the number of needle passes was significantly greater in the AL group. Artery puncture did not differ significantly by method of vein localization. Conclusion: Vein localization by audio Doppler significantly increases the rate of successful central venous cannulation and decreases the number of needle passes in pediatric patients when used by inexperienced operators.

Central venous cannulation in infants and children: a comparison of internal and external jugular vein approaches

SummaryWe prospectively evaluated success rate and complications associated with 436 internal (IJ) and external (EJ) jugular approaches to central venous cannulation in 377 paediatric patients. Variables studied included the route of insertion, success rate, cannulation time, intraoperative and postoperative catheter‐related complications. The overall success rate and the frequency of complications were higher with the IJ than with the EJ approach. Cannulation with the EJ approach was more successful in older patients than in younger ones, making EJ a more attractive route for central venous cannulation in older children. While the inconsistent final position of the catheter tip makes EJ a less reliable technique for central venous pressure monitoring, it does not limit its usefulness for infusion of vasoactive drugs. If monitoring of filling pressures is desired, the IJ approach is a better choice, despite its higher risk of complications.

Venous Cannulation in Infants and Children

Venous Cannulation in Infants and Children