Ultrasound evaluation of techniques for internal jugular vein puncture in children

Abstract

Purpose:To determine by ultrasound which access and position the child must stay to obtain the best transversal section of the right Internal Jugular Vein (RIJV) allowing a safer puncture. Methods: Three possible accesses to the RIJV, anterior, lateral and posterior, from 57 healthy children, were analyzed through ultrasound images in a sequence of positions of the head, in supine position, with or without a roll under the scapula: head centered in neutral position with and without a roll (NPP and NP); contra lateral rotation with and without a roll (CLRP and CLR), neutral position and the patient raised in 30° in Trendelenburg position (TDG). To analyze the results it was applied one statistic method, with variation analysis to the same individuals. Basic Procedures: Ultrasound evaluation in each one of the proposed positions. Results: The statistical analysis of the results observed that the lateral puncture with the patient in the neutral position, in Trendelemburg without a roll, offers a bigger area in comparison to all the other options of puncture and positioning of the patient (p<0, 0001). Conclusion: The safer way for the puncture of RIJV in children is obtained in neutral position in Trendelemburg by lateral puncture, without a shoulder roll. Key words: Jugular Veins. Ultrasonics. Child. RESUMOObjetivo: Determinar pelo ultra-som qual o melhor acesso e posicionamento da criança com o intuito de se obter a melhor secção transversal da veia jugular interna direita (VJID), permitindo uma punção com maior segurança. Métodos: Três possíveis acessos a VJID, anterior, lateral e posterior foram analisados pela ultrassonografia em uma sequência de diferentes posições da cabeça, estando o paciente em posição supina com ou sem um coxim sob a escápula; cabeça na posição neutra; (NPP E NP); rotação lateral da cabeça (CLRP e CLR), posição neutra com o paciente em posição de Trendlemburg a 30 0 (TDG). Para analisar os resultados foi aplicado um método estatístico com análise variada sobre os mesmos indivíduos. Procedimentos básicos: Avaliação ultrassonográfica em cada uma das posições propostas. Resultados: Pela análise estatística dos resultados observou-se que a punção lateral estando o paciente em posição neutra, em Trendlemburg sem a colocação de coxim sob a escápula oferece uma área maior em comparação a todas as outras opções de punção e posicionamento do paciente (p<0,0001). Conclusão: A melhor técnica para a punção da VJID em crianças foi a posição neutra em Trendlemburg, por punção lateral , sem a colocação de um coxim sob a escápula.

Comparison of the Trendelenburg position versus upper-limb tourniquet on internal jugular vein diameter

“…The Trendelenburg position is the most preferred because it increases venous return and IJV diameter. 17 It also reduces the risk of air embolism. 1 , 5 , 8 Apart from this, the Valsalva manoeuvre and hepatic compression are used to increase the venous return and IJV diameters.…”

Ultrasound guided internal jugular vein access in children and infant: A meta‐analysis of published studies

“…Position of the head and the landmarks chosen for IJV access has been shown by Schettini and Coll (14) and Ybarra and Coll (21) to influence the diameter of IJV, which in turns influence the difficulties in catheterization. Interestingly, the best position was not that classically used during IJV canulation in children (the contra lateral rotation of the head with a roll under the shoulder) but the neutral position without a roll and in the Trendelenburg position (14,21). The classical position described during adult IJV access used in all included studies might not be the most suitable in children and infants.…”

“…The smaller dimension of IJV in children increases the number of attempts; favors the changes in puncture points and the depth of needle insertion; and finally increases the risks of complications such as carotid artery puncture or pneumothorax. Second, many ultrasound studies have found variations in IJV position relative to the common carotid artery, with the IJV being anterior to the carotid artery in many cases (1,14–16). This position might also increase the risks of carotid artery puncture.…”

Long‐term complications in totally implantable venous access devices: Randomized study comparing subclavian and internal jugular vein puncture

“…The Seldinger technique was used for venous puncture [20] in association with the split sheath technology. For implantations in the internal jugular vein, the puncture was carried out at the medial edge of the clavicular head of the sternocleidomastoid muscle, two centimeters above the upper edge of the clavicle [21,22]. For implantations into the subclavian vein, the puncture parameter was the midpoint of the clavicle.…”