Central Venous Access in Children Via the External Jugular Vein

Humphrey, Michael; Blitt, Casey D.

doi:10.1097/00000542-198207000-00015

Cited by 17 publications

(14 citation statements)

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“…This is similar to that found by Humphrey and Blitt [3] who quoted a rate of 59% of actual attempts. However, in our study we found a positive correlation between successful cannulation and patient age.…”

Section: Discussionsupporting

confidence: 91%

“…Our smaller and lighter subject population may therefore explain our slightly lower success rate. Previous authors [3,4] have suggested that a smaller radius of curvature 'J' wire would be beneficial in children, allowing the 'J' to reform in smaller vessels and hence allow optimal utilisation of the basic 'J' wire principle. As 3 mm 'J' wires have been shown to be optimal in adults [5] we would anticipate that 1.5 mm radius 'J' wires, available since the completion of our series, would be more suitable for most children.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 93%

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Central venous access in children via the external jugular vein

Taylor¹,

Mowbray²

1992

Anaesthesia

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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...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Central venous access in children via the external jugular vein

Taylor¹,

Mowbray²

1992

Anaesthesia

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“…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].…”

Section: Discussionsupporting

confidence: 89%

“…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.…”

Section: Discussionsupporting

confidence: 85%

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

2006

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Central venous access is frequently used in infants and children with a wide variety of conditions. This report evaluates our experience and the complications from central venous catheters (CVC) placed percutaneously in children at a public hospital of a developing country-Brazil. To identify associated complications, data were collected prospectively and 155 consecutive catheterizations in children at a public hospital over a nearly 8-month period were analyzed. Data collected included sex, age, weight, primary diagnosis, indication for placement, presence of blood coagulation disturbance, hospital department for procedure, type of anesthesia, type of catheter (diameter, lumen number, material), site of catheterization, number of attempts, number of puncture sites, complications during puncture, the time catheter remained in place, later complications (mechanical, infectious) and reason for catheter removal. A total of 155 catheters were placed in 127 patients. There were 130 neck lines and 25 groin lines. The success rate was 81.9% at the initially chosen puncture site and rose to 100% with the inclusion of the second site. Perioperative complications occurred in nine (5.8%) cases, including six (3.9%) hematomas and three (1.9%) arterial puncture. There was no pneumothorax, hemothorax or hydrothorax. During the time the catheter remained in place, there were 51 (32.9%) complications, of which 33 (21.3%) were mechanical and 18 (11.6%) suspected catheter-related infection. These complications were responsible for the removal of the catheter. Despite the relatively high complication rate there were no catheter-related deaths. Body weight was significantly lower for children who underwent more than one puncture site (P=0.01). Age, sex, type of catheter and primary diagnosis were not associated with complications. Knowledge of anatomy and familiarity with the Seldinger technique highly increase the catheterization success rate, with few surgical complications. A better nursing care of CVC is emphasized. The available modern venous catheters at a public hospital in Brazil have contributed to improve the quality of pediatric medical care. Nowadays, the percutaneous CVC is the preferred method in pediatric patients.

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Anesthesia for Pediatric Renal Transplantation

Adler¹,

Gibbons²

1987

Anesthesia for Renal Transplantation

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Central Venous Access in Children Via the External Jugular Vein

Cited by 17 publications

References 0 publications

Central venous access in children via the external jugular vein

Central venous access in children via the external jugular vein

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

Anesthesia for Pediatric Renal Transplantation

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