• Halil Keskin, Filiz Keskin, Pelin Aydin, Muhammet Akif Guler, and Ali Ahiskalioglu.
• Department of Pediatric Intensive Care Unit, Ataturk University School of Medicine, Erzurum, Turkey; Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey. Electronic address: keskinpediatrize@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2021 Jul 1; 35 (7): 2094-2099.

ObjectiveAlthough pediatric central venous catheterization is performed using ultrasound guidance, it is still a challenge. This study aimed to investigate the efficacy of the syringe-free, long-axis in-plane approach and compared the short-axis classic out-of-plane approach for ultrasound-guided central venous catheter placement in critically ill pediatric patients.DesignProspective randomized study.SettingSingle institution, tertiary university hospital, pediatric care unit.ParticipantsThe study comprised 60 patients ages three months to 15 years.InterventionsParticipants were randomly divided into two equal groups. Group I (n = 30) incorporated patients who underwent the long-axis, syringe-free in-plane approach, and group II (n = 30) incorporated patients who underwent the short-axis out-of-plane approach.Measurements And Main ResultsPerforming time, number of needle passes, number of skin punctures, first-pass success rate, and related complications were evaluated. There were no differences between the two groups in terms of demographics and vein-related measurements (p > 0.05). Performing time was statistically shorter in group I compared with group II (32 [25-38] v 58 [42-70] s; p < 0.001). There was no statistical difference between first-pass success rates between groups (group I 86.6% v group II 80%; p = 0.731). There were no significant differences between the groups in the number of needle passes and skin punctures (p = 0.219 and 0.508, respectively). Complications occurred in both groups, but there was no significant difference (4/30 v 7/30; p = 0.317).ConclusionsThe syringe-free, long-axis in-plane approach can be a safe and fast alternative for pediatric catheterization.Copyright © 2021 Elsevier Inc. All rights reserved.

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