Audio-Doppler guidance using a small-caliber Doppler probe for internal jugular venous puncture for central venous catheterization in infants and children

Background: We evaluated an audio-Doppler with a small-caliber probe as a guide for central venous cannulation (CVC) via the internal jugular vein (IJV) in infants and children. Methods: The right IJV was located with a small-caliber (2.0 mm in diameter) audio-Doppler probe using 10 MHz ultrasound. The probe was placed on the neck about the level of sixth cervical vertebra and was moved until the crisp pulsatile sound of the carotid artery was identified. Then the probe was moved laterally to identify the low-pitched venous hum of the right IJV. After marking the puncture site on the skin, a sterile cannulation procedure was performed. Ultimate success rate, cannulation time <10 min, successful cannulation within three punctures, and complications were recorded. Results: Ultimate success rate was 65.6% (42/64) in infants (<12 m), and 94.7% (72/76) in children (12 m or older). Cannulation time <10 min was 48.4% in infants, and 85.5% in children. Successful cannulation within three punctures was 45.3% in infants and 82.8% in children. Three carotid arterial punctures occurred. Conclusions: We were not able to demonstrate absolute superiority of the results utilizing this device over the reported results of traditional landmark techniques for CVC via the right IJV. However, this device may contribute to reducing complications and be of value in teaching residents where to insert a needle for an internal jugular puncture.