Teaching successful central venous cannulation in infants and children: Audio Doppler versus anatomic landmarks

Objective: To determine if vein localization with an audio Doppler increases successful central Venous cannulation and decreases complications in infants and children when performed by inexperienced operators, compared with vein localization by anatomic landmarks (ALs). Design:A prospective cohort of infants and children undergoing central venous cannulation for cardiac surgery. Setting: A university-affiliate children's hospital with a pediatric anesthesia fellowship program. Participants: All infants and children undergoing cardiac surgery between July 1, 1996, and January 1, 1997. Interventions:Subjects had central venous catheters (CVCs) placed by an anesthesia fellow by either ALs or audio-Doppler localization of the veins. Measurements and Main Results: Eighty-four children were studied. Internal jugular Vein (IJV) cannulation was attempted in 71 (85%) children and femoral vein cannulation 13 (15%) children. Time to catheter insertion, number of needle passes, and artery puncture were noted. Sixty-one of 63 (97%) children had successful central venous cannulation by an anesthesia fellow using audio-Doppler vein localization. This was significantly greater than the 13 of 21 (62%) successful cannulations among children who had veins localized by ALs. Time to insertion did not differ by method of Vein localization; however, the number of needle passes was significantly greater in the AL group. Artery puncture did not differ significantly by method of vein localization. Conclusion:Vein localization by audio Doppler significantly increases the rate of successful central venous cannulation and decreases the number of needle passes in pediatric patients when used by inexperienced operators. Copyright (C) 1998 by W.B. Saunders Company.