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Use of Transthoracic Echocardiography Probe for Locating the Internal Jugular Vein to Assist Cannulation In Children and Its Comparison With the Standard Landmark Technique

Objectives: The objective was to verify the validity of transthoracic echocardiography (TTE) probe for guiding the central venous catheter placement and to ascertain whether the ultrasound (US) guidance is superior to the landmark technique in terms of success rate, procedure time, and complication rate. Design: Prospective, randomized. Setting: Tertiary care, superspeciality hospital, single Institute. Participants: Pediatric cardiac surgical patients. Interventions: The study included 105 patients <12 years age, randomized into two groups. In the control group (Group A), internal jugular vein (IJV) cannulation was performed by the conventional landmark technique. In the US group (Group B), the course of the IJV was marked on the skin surface before cannulation using a 3-8 MHz TTE probe. The success rate, number of attempts, cannulation time, and complication rate were compared in the two groups. Results: Overall success rate (right IJV cannulation performed within five finder needle attempts) (95.9% vs. 82.1%, P < 0.05) and first-attempt success rate (right IJV cannulation performed within one finder needle attempt) (77.6% vs. 53.6%, P < 0.01) were higher in Group A. The number of attempts to locate the vein with finder needle (mean 2.8 ± 2.5 vs. 1.6 ± 1.6, median in both groups 1.0, P < 0.01) and puncture needle (mean 2.0 ± 1.5 vs. 1.5 ± 1.0, median in both groups 1.0, P < 0.05) were more in Group B. The cannulation time was more in Group B (413 ± 317 s vs. 233 ± 164 s, P = 0.001). A sub-group analysis of children weighing >10 kg did not reveal any differences in the above parameters. Conclusion: The success rate of IJV cannulation in infants and children is not improved with US guidance. Significantly better success rate was observed with the landmark technique as compared with the US guidance. On sub-group analysis, this difference was not observed in children weighing >10 kg.