The Clavicular Notch as an Alternate Anatomical Landmark for Internal Jugular Vein Cannulation in Infants and Children: A Descriptive Study

Abstract

Objective: To evaluate an alternate anatomical landmark technique for internal jugular vein cannulation in infants and children. Aim: To evaluate the success and safety of the clavicular notch as a bony landmark for central venous cannulation in infants and children. Background: Central venous cannulation can be particularly difficult in infants and children. While ultrasound-guided techniques are well established, the majority of central venous catheters are placed using landmark guidance with variable success rate. This prospective study documents the success and safety of a modified landmark technique using the clavicular notch as a bony landmark for central venous cannulation in this group of patients. Materials and methods: One hundred and fifty children under 12 years of age belonging to ASA grade I to III were included in the study. All children were placed in 150 trendelenberg position with head rotated 40º to the opposite side. The relationship of the IJV to the carotid artery was noted by audio Doppler. The notch technique was used only if the IJV was detected by Doppler at the notch. Using the standard seldinger technique the IJV was cannulated and the complications were noted. The traditional approach was our rescue method. Results: The IJV was localized at the clavicular notch in 95.33% (143/150) cases by audio Doppler and the overall successful cannulation rate was 98.6% (141/143). We encountered complications in 13 (8.6%) cases, none of which had any adverse outcome. Conclusion: This study confirms the consistent location of IJV at the clavicular notch. Therefore, the 'Notch technique' can be used successfully for IJV cannulation in infants and children.