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Canadian Journal of Anesthesia 51:A90 (2004)
© Canadian Anesthesiologists' Society, 2004

Abstracts - Tuesday June 22nd 2004 1030-1230

ULTRASOUND-GUIDED INTERNAL JUGULAR ACCESS IN INFANTS AND CHILDREN

Toshimi Arai, MD and Masao Yamashita, MD

Department of Anesthesiology, Ibaraki Children’s Hospital, 3-3-1, Futaba-dai, Mito, Ibaraki, 311-4145, Japan

Introduction:

In infants and children, percutaneous access of the right internal jugular vein (IJV) based on anatomical landmarks is not always easy. Therefore, ultrasound-guided techniques for cannulation of the IJV have been described, and their use has been shown to increase the success rate and decrease the incidence of complication in infants and children 1)2). We compared the use of a small-caliber audio-Doppler probe with an ultrasound scanner when cannulating the right IJV in infants and children.

Methods:

The protocol was approved by the institutional Ethical Committee and written parental consent was obtained. Sixty-two infants and children undergoing cardiac surgery were randomized into two groups (ultrasound scanner group: US, and audio-Doppler group: AD). Under endotracheal general anaesthesia, the patient was positioned in the 15-20 degree Trendelenburg position with a shoulder roll inserted to allow extension of the head. The head was placed in the midline position. In the ultrasound scanner group, cannulation was guided using an ultrasound scanner image (Site-Rite II, Dymax Corporation, Pittsburgh, USA). In the audio-Doppler group, the pathway of the right IJV was located with the small-caliber probe (2mm in diameter, Bidirectional Velocity Meter, HD-307, HAYASHI Electronic, Tokyo, Japan) and marked on the skin, then the vessele was punctured using sterile technique. Success rate on the first attempt, cannulation time within 5min, ultimate success rate, and incidence of complications were recorded.

Results:


US AD
success rate on the first attempt 65.5% (19/29) 39.4% (13/33) P<0.05
cannulation time within 5min 75.9% (22/29) 60.6% (20/33) N.S.
ultimate success rate 89.7% (26/29) 78.8% (26/33) N.S.
Complications : hematoma 1 3
 : arterial puncture 0 2

Discussion:

Both devices were helpful in cannulation of the IJV in infants and children. The success rate on the first attempt was higher with an ultrasound scanner.

References:

1 Masui 1996; 45: 1424–1429.[Medline]

2 BMJ 2003; 16; 327(7411):361.





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