• S L Bratton, C Ramamoorthy, J B Eck, and G K Sorensen.
• University of Washington School of Medicine, Seattle, USA.
• J. Cardiothorac. Vasc. Anesth. 1998 Oct 1;12(5):523-6.

ObjectiveTo 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).DesignA prospective cohort of infants and children undergoing central venous cannulation for cardiac surgery.SettingA university-affiliated children's hospital with a pediatric anesthesia fellowship program.ParticipantsAll infants and children undergoing cardiac surgery between July 1, 1996, and January 1, 1997.InterventionsSubjects had central venous catheters (CVCs) placed by an anesthesia fellow by either ALs or audio-Doppler localization of the veins.Measurements And Main ResultsEighty-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.ConclusionVein 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.

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