Comparison Between Central Venous Catheter Placement and Ultrasound Guide and Anatomical Landmarks in Pediatric Patients Undergoing Cardiac Surgeries

Document Type : Original Article

Authors

1 Department of Cardiac Anesthesia, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: Controversies exist surrounding the advantages and disadvantages of anatomical landmarks (ALs) and ultrasound (US) guidance as 2 methods of central venous catheter (CVC) placement among pediatric patients. The present study compared the success rate and complications of CVC placement in the internal jugular vein between US guidance and traditional AL methods among pediatric patients.
Methods: The present open-labeled randomized clinical trial was performed on 120 pediatric patients aged 3 months to 6 years undergoing cardiac surgeries. The patients were randomly allocated to the US-guided and AL groups. After the induction of anesthesia and intubation, the CVC was placed according to the placement method of each trial group. The success rate of first-attempt CVC placements was the primary outcome, while placement time, vein punctures, and arrhythmias constituted the secondary outcomes.
Results: The trial assessed 120 patients (63, 52.5% female). The mean CVC placement time was 204.1±111.7 seconds. The success rate of first-attempt CVC placements was the same in both groups (47/60; 78.33%). The AL group experienced significantly more side effects than the US-guided group (23 arrhythmias [38.33%]   and 5 arterial punctures [8.33%] vs 2 arrhythmias [3.33%] and 3 arterial punctures [5%]; P<0.001).
Conclusions: The complication rate of CVC placement in the US-guided group was lower than that in the AL group; thus, the former method can be considered safer in pediatric patients. (Iranian Heart Journal 2023; 24(2): 55-61)

Keywords

References

  1. Bouaziz H, Zetlaoui PJ, Pierre S, Desruennes E, Fritsch N, Jochum D, et al. Guidelines on the use of ultrasound guidance for vascular access. Anaesthesia Critical Care & Pain Medicine. 2015; 34(1):65-9.
  2. Bodenham A, Babu S, Bennett J, Binks R, Fee P, Fox B, et al. Association of Anaesthetists of Great Britain and Ireland: safe vascular access 2016. Anaesthesia. 2016; 71(5):573-85.
  3. Lamperti M, Bodenham AR, Pittiruti M, Blaivas M, Augoustides JG, Elbarbary M, et al. International evidence-based recommendations on ultrasound-guided vascular access. Intensive care medicine. 2012; 38(7):1105-17.
  4. Dassinger MS, Renaud EJ, Goldin A, Huang EY, Russell RT, Streck CJ, et al. Use of real-time ultrasound during central venous catheter placement: results of an APSA survey. 2015; 50(7):1162-7.
  5. de Souza TH, Brandão MB, Nadal JAH, Nogueira RJNJP. Ultrasound guidance for pediatric central venous catheterization: a meta-analysis. 2018; 142(5).
  6. Alderson P, Burrows F, Stemp L, Holtby HJBjoa. Use of ultrasound to evaluate internal jugular vein anatomy and to facilitate central venous cannulation in paediatric patients. 1993; 70(2):145-8.
  7. Shime N, Hosokawa K, MacLaren GJPCCM. Ultrasound imaging reduces failure rates of percutaneous central venous catheterization in children. 2015; 16(8):718-25.
  8. Grebenik C, Boyce A, Sinclair M, Evans R, Mason D, Martin BJBjoa. NICE guidelines for central venous catheterization in children. Is the evidence base sufficient? 2004; 92(6):827-30.
  9. Verghese ST, McGill WA, Patel RI, Sell JE, Midgley FM, Ruttimann UEJTJotASoA. Ultrasound-guided internal jugular venous cannulation in infants: a prospective comparison with the traditional palpation method. 1999; 91(1):71-7.
  10. Froehlich CD, Rigby MR, Rosenberg ES, Li R, Roerig P-LJ, Easley KA, et al. Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit. 2009; 37(3):1090-6.
  11. Alten JA, Borasino S, Gurley WQ, Law MA, Toms R, Dabal RJJPCCM. Ultrasound-guided femoral vein catheterization in neonates with cardiac disease. 2012; 13(6):654-9.
  12. Oulego-Erroz I, González-Cortes R, García-Soler P, Balaguer-Gargallo M, Frías-Pérez M, Mayordomo-Colunga J, et al. Ultrasound-guided or landmark techniques for central venous catheter placement in critically ill children. 2018; 44(1):61-72.
  13. Pietroboni P, Carvajal C, Zuleta Y, Ortiz P, Lucero Y, Drago MJMI. Landmark versus ultrasound-guided insertion of femoral venous catheters in the pediatric intensive care unit: An efficacy and safety comparison study. 2020; 44(2):96-100.
  14. Yang EJ, Ha HS, Kong YH, Kim SJJKjop. Ultrasound-guided internal jugular vein catheterization in critically ill pediatric patients. 2015; 58(4):136.
  15. Lau CS, Chamberlain RS. Ultrasound-guided central venous catheter placement increases success rates in pediatric patients: a meta-analysis. Pediatr Res. 2016; 80(2):178-84.
  16. Ullman AJ, Marsh N, Mihala G, Cooke M, Rickard CM. Complications of Central Venous Access Devices: A Systematic Review. Pediatrics. 2015; 136(5):e1331-44.
  17. Gurien LA, Blakely ML, Russell RT, Streck CJ, Vogel AM, Renaud EJ, et al. Real-time ultrasonography for placement of central venous catheters in children: A multi-institutional study. Surgery. 2016; 160(6):1605-11.
  18. Marin JR, Abo AM, Arroyo AC, Doniger SJ, Fischer JW, Rempell R, et al. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. Crit Ultrasound J. 2016; 8(1):16.
  19. Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization. Cochrane Database Syst Rev. 2015; 1:CD006962.
  20. E PSN, Grousson S, Duflo F, Tahon F, Mottolese C, Dailler F. Ultrasonographic anatomic variations of the major veins in paediatric patients. Br J Anaesth. 2014; 112(5):879-84.
  21. Gallagher RA, Levy J, Vieira RL, Monuteaux MC, Stack AM. Ultrasound assistance for central venous catheter placement in a pediatric emergency department improves placement success rates. Acad Emerg Med. 2014; 21(9):981-6.
  22. Vieira RL, Gallagher RA, Stack AM, Werner HC, Levy JA. Development and evaluation of a program for the use of ultrasound for central venous catheter placement in a pediatric emergency department. Pediatric emergency care. 2013; 29(12):1245-8.
Iranian Heart Journal
Volume 24, Issue 2
April 2023
Pages 55-61

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