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. 2018 Mar;62(3):208-213.
doi: 10.4103/ija.IJA_676_17.

Ultrasound guided internal jugular vein cannulation in infants: Comparative evaluation of novel modified short axis out of plane approach with conventional short axis out of plane approach

Amit Rastogi  1 , Aarti Agarwal  1 , Puneet Goyal  1 , Vansh Priya  2 , Sanjay Dhiraaj  1 , Rudrashish Haldar  1
Affiliations

Ultrasound guided internal jugular vein cannulation in infants: Comparative evaluation of novel modified short axis out of plane approach with conventional short axis out of plane approach

Amit Rastogi et al. Indian J Anaesth. 2018 Mar.

Abstract

Background and aims: Central venous cannulation (CVC) through right internal jugular vein (IJV) route is routinely performed in paediatric patients undergoing major surgery and in those admitted to intensive care units. A novel technique (modified short-axis out-of-plane [MSA-OOP]) to improve first pass success rate of ultrasound-guided IJV CVC in neonates and infants is being compared with conventional SA-OOP method.

Methods: A total of 120 patients were enroled in the study over a period of 6 months. All paediatric patients with age <1 year and weight <10 kg who underwent a major surgery requiring CVC were included. Patients were randomised to either of the two approaches of ultrasound-guided IJV cannulation; SA-OOP and modified SA-OOP (MSA-OOP). In modified approach, the midline of probe footprint was marked with a radio-opaque barium wire that casted a central acoustic shadow on ultrasound screen.

Results: In MSA-OOP group, 83.1% of patients were cannulated in the first attempt as compared to 49.2% patients in group SA-OOP. Patients in MSA-OOP group required significantly fewer attempts for successful CVC as compared to patients in the SA-OOP group ( MSA-OOP: median = 1, interquartile range [1-1]; SAOOP: median = 2, interquartile range [1-2], P < 0.001, Mann-Whitney U-test).

Conclusion: The use of MSA-OOP ultrasound technique for IJV CVC cannulation results in a higher first-attempt success rate and reduces the number of cannulation attempts.

Keywords: Central venous cannulation; neonates and infants; ultrasound guided vascular access.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) High frequency linear transducer of 25 mm footprint with barium wires in centre of probe covered with sonogel and sterile film. (b) Preparation of linear ultrasound probe by wrapping with sterile drape before attempting central venous cannulation
Figure 2
Figure 2
(a) Acoustic shadow of barium wire on ultrasound screen, pointed by arrow head. (b) Alignment of acoustic shadow of barium wire and right internal jugular vein just below it in the centre of screen
Figure 3
Figure 3
Position of ultrasound machine and operator during procedure
See this image and copyright information in PMC

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