Internal jugular vein cannulation in infants and children using a new portable ultrasound designed for vascular access

Abstract

Objectives: Internal jugular vein puncture for infants or small children is still not an easy technique. Recent investigations have shown the usefulness of ultrasound for identifying the internal jugular vein during puncture, specifically in adults. The present study established a simple marking technique using a new portable ultrasound device for vascular access (iLOOK25) and assessed whether the method improves success rate of internal jugular vein puncture performed by anesthesiologists in-training. Methods: Subjects comprised 64 infants and children (body weight<20kg) undergoing elective cardiac surgery. Patients were randomized into 2 groups. In Group A, the internal jugular vein was punctured only by a guide of palpating the carotid artery, without any ultrasound imaging. In Group B, the internal jugular vein was punctured according to a marking on the skin surface indicating the position of the internal jugular vein as detected by ultrasound. Results: The success ratio of internal jugular vein cannulation was significantly higher in Group B (97%) than in Group A (62%; P=0.0008) No clinically significant subcutaneous hematoma or pneumothorax were observed in both groups. Moreover, the cost of the ultrasound appears to be compensated if the ultrasound technique is used for approximately 600 patients. Conclusions: A skin-marking technique with guidance by portable ultrasound, but without real-time, is useful for improving the success of internal jugular vein cannulation in infants or small children for anesthesiologists in a teaching general hospital. This method contributes to improvements in patient safety.