Central venous access in children via the external jugular vein

Abstract

SummarySixty-two children undergoing cardiac surgery were surveyed for the presence of external jugular veins. When present, these were used as a route for central venous catheterisation using a 'J' wire Seldinger technique. Only 54% of attempted insertions were successful but the results support greater efJacy in older children. Key wordsVeins; jugular, external, cannulationThe external jugular vein (EJV) provides a safe and reliable route for central venous access in adults especially where a 'J' wire technique is employed [1,2]. A lower success rate was reported in a small series of children and showed no correlation with patient size [3]. We aimed to assess the suitability of this approach in children in a larger paediatric series. MethodThe presence of EJVs was determined in children presenting for cardiac surgery. After induction of anaesthesia, the child was tilted 15" head down and the EJV was cannulated with a 20 G Abbocath cannula, using full aseptic technique. A J-shaped guidewire (radius of curvature of J = 3 mm) was then inserted into the cannula and manoeuvred into a central vein. Finally, after removal of the short cannula, a 22 G hydromer-coated polyurethane catheter was advanced over the guidewire and secured in place. Satisfactory placement was ascertained initially by aspiration of blood through the catheter and after the procedure was confirmed by chest radiography. Duration in situ and any complications were noted. All central line tips were sent after removal for bacterial culture. ResultsThe children's range of age and weight are illustrated in Figures 1 and 2. The mean age was 41 months and mean 7n " , . , . , , , , . . weight was 13.9 kg. Twenty-nine subjects were male and 33 were female. Fifty-eight of the 62 subjects (93.5%) had one or more visible EJV and initial cannulation was successful in 50 children (80.6%). Only 33 'J' wires (53.2%) were successfully manipulated into a central vein. Catheters passed easily over the 'J' wires, but two were subsequently found to be malpositioned. In both of these cases the catheters had passed in a cephalad direction along the internal jugular vein, one ipsilaterally, the other contralaterally. The ages, in years, of the successes and failures are shown in Fig. 3, and suggest increased success with age. This was confirmed when the ages in months were compared by calculating the Spearman Rank Correlation Coefficient (r, = 0.84) which showed that age had a statistically significant effect (p < 0.001) upon success. This result is more easily appreciated by comparing the success rate in those subjects less than 3 years old (37%) and those above this age (71%). Despite all cannulations being performed by the same anaesthetist, the success rate did not improve with greater experience of the technique over the course of the study. No pneumothorax or carotid puncture occurred. Staphyloccoccus albus was cultured from three of the catheter tips, but none of the children had evidence of systemic sepsis. The duration that successful cannulations remained in s...

Central venous catheter placement in children: a prospective study of complications in a Brazilian public hospital

“…The overall success rate found in the present study (100%) corroborates other published studies (59-100%), which characterize the pediatric application of the Seldinger technique as safe and with low morbidity (5.8%) [11][12][13][14][15][16][17][18][19][20]. The profile of this case series does not differ from other studies [1,16,18,21].…”

“…The mean age of 4 years is similar to the majority of reports in the literature. Although age and weight were reported previously as factors associated with lower rates of success by some authors [7,13,17,19,20], these factors did not influence our global success rate. However, we observed that in children with a lower body weight a change of puncture site for CVC was statistically significant (P<0.05).…”

“…Several studies have examined the morbidity and mortality associated with central venous catheterization in children, reporting complication rates of 0.7-23% [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. The most common complications, such as arterial puncture, hematoma and pneumothorax, varied according to the puncture site [1,24].…”

Percutaneous central venous catheterization through the external jugular vein in children: improved success rate with body maneuvers and fluoroscopy assistance

“…All articles regarding this subject report use of peripherally inserted central catheters or double-lumen short-term catheters for catheterization of the external jugular vein [5][6][7][8]. In almost 25% of our patients, a long-term catheter was inserted, thus presenting a further option to avoid major risks in selected patients.…”

“…The first report in children was in 1982, but the authors reported only a 59% success rate [6]. Taylor et al [7] reported a 54% success rate, suggesting that there might be a higher efficacy in older children. A recent study reported a 72.5% success rate of central venous catheterization through the external jugular vein and claimed it to be the highest one ever reported in children.…”