A randomized-controlled study of ultrasound prelocation vs anatomical landmark-guided cannulation of the internal jugular vein in infants and children

Background: A specifically designed ultrasound scanner may be helpful in percutaneous cannulation of the internal jugular vein in pediatric patients. We report a new two-dimensional (2D) ultrasound prelocation (UL) technique using a transesophageal echocardiography (TEE) intraoperative probe instead of the portable scanner, and have compared the new technique with conventional anatomical landmark method (AL) for central venous catheterization in infants and children. Methods: Sixty-two infants (body weight < 12 kg) undergoing elective surgery for congenital heart disease were randomized into two groups. In the AL group, the landmark for cannulation was the palpation of the common carotid pulsation or the sternocleidomastoid triangle. In the UL group, the central vein was located by 2D ultrasonic imaging using a TEE intraoperative probe for HP SONOS 4500. The number of cannulation attempts, success rate, and complication rate were recorded. Results: For the UL and AL groups, the cannulation success rate was 100% and 80% (P < 0.05), the incidence of arterial puncture was 3.1% and 26.7% (P < 0.025), and the number of attempts was 1.57 +/- 1.04 and 2.55 +/- 1.76 (P < 0.001), respectively. Conclusions: Two-dimensional ultrasound prelocated central venous catheterization in infants and children is convenient and can markedly increase cannulation success rate and reduce the incidence of complications.