• Paediatric anaesthesia · May 2009

    Randomized Controlled Trial Comparative Study

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

    • Wenjing Xiao, Fuxia Yan, Hongwen Ji, Mingzheng Liu, and Lihuan Li.
    • Cardiovascular Institute & Fuwai Cardiovascular Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China.
    • Paediatr Anaesth. 2009 May 1;19(5):481-6.

    BackgroundCentral 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.MethodsOne 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.ResultsThe 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).ConclusionsCompared 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.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…