Ultrasound-guided versus landmark-guided femoral vein access in pediatric cardiac catheterization

This study aimed to evaluate whether an ultrasound-guided technique can improve upon a landmark-guided technique in achieving femoral vein access in pediatric cardiac catheterization. This study examined 87 consecutive subjects with a median age of 2 years (range, 1 month to 19 years) who had congenital or other heart disease. Femoral vein puncture was attempted using either an ultrasound-guided technique (US group, n = 43) or a landmark-guided technique (LM group, n = 44). The patients were assigned alternately to either an ultrasound- or landmark-guided group. Overall success and traumatic complication rates were compared between the two groups, as well as the influence of patient size and age. The overall rate of success in achieving femoral vein access did not differ between the two groups. Among the successful cases in the two groups, there were no significant differences in patient size or age. Inadvertent femoral artery puncture occurred with 3 (7%) of 43 patients in the US group and with 14 (31.8%) of 44 patients in the LM group, for a significantly higher complication rate in the LM group (p < 0.01). Ultrasound-guided access to the femoral vein minimizes the complication of inadvertent arterial puncture as compared with the landmark-guided approach.