A randomized study of a new landmark‐guided vs traditional para‐carotid approach in internal jugular venous cannulation in infants

作者：Wenjing Xiao, Fuxia Yan, Hongwen Ji, Mingzheng Liu, Lihuan Li · 发表于：Pediatric Anesthesia · 年份：2009 · DOI：10.1111/j.1460-9592.2009.02989.x · 被引用次数：7 · 研究领域：Central Venous Catheters and Hemodialysis、Vascular anomalies and interventions、Congenital Heart Disease Studies

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 art...