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, Lihuan Li
Paediatric Anaesthesia 2009, 19 (5): 481-6

BACKGROUND: Central 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.

METHODS: One 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.

RESULTS: The 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).

CONCLUSIONS: Compared 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.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"