• Jun Takeshita, Kazuya Tachibana, Yasufumi Nakajima, Gaku Nagai, Ai Fujiwara, Hirofumi Hamaba, Hideki Matsuura, Tomonori Yamashita, and Nobuaki Shime.
• Department of Anesthesiology, Osaka Prefectural Hospital Organization, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan.
• Pediatr Crit Care Me. 2020 Nov 1; 21 (11): e996-e1001.

ObjectivesThe aim of this study was to compare the occurrence of posterior wall puncture between the long-axis in-plane and the short-axis out-of-plane approaches in a randomized controlled trial of pediatric patients who underwent cardiovascular surgery under general anesthesia.DesignProspective randomized controlled trial.SettingOperating room of Osaka Women's and Children's Hospital.PatientsPediatric patients less than 5 years old who underwent cardiovascular surgery.InterventionsUltrasound-guided central venous catheterization using the long-axis in-plane approach and short-axis out-of-plane approach.Measurements And Main ResultsThe occurrence of posterior wall puncture was compared between the long-axis in-plane and short-axis out-of-plane approaches for ultrasound-guided central venous catheterization. Patients were randomly allocated to a long-axis group or a short-axis group and underwent ultrasound-guided central venous catheterization in the internal jugular vein using either the long-axis in-plane approach (long-axis group) or the short-axis out-of-plane approach (short-axis group). After exclusion, 97 patients were allocated to the long-axis (n = 49) or short-axis (n = 48) groups. Posterior wall puncture rates were 8.2% (4/49) and 39.6% (19/48) in the long-axis and short-axis groups, respectively (relative risk, 0.21; 95% CI, 0.076-0.56; p = 0.0003). First attempt success rates were 67.3% (33/49) and 64.6% (31/48) in the long-axis and short-axis groups, respectively (relative risk, 1.04; 95% CI, 0.78-1.39; p = 0.77). Overall success rates within 20 minutes were 93.9% (46/49) and 93.8% (45/48) in the long-axis and short-axis groups, respectively (relative risk, 0.99; 95% CI, 0.90-1.11; p = 0.98).ConclusionsThe long-axis in-plane approach for ultrasound-guided central venous catheterization is a useful technique for avoiding posterior wall puncture in pediatric patients, compared with the short-axis out-of-plane approach.

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