CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S1-S2
DOI: 10.1055/s-0041-1730647
Abstract

Ultrasound-Guided Central Venous Access Application in the Neonatal and Early Pediatric Intensive Care Unit (Single-Center Experience in 1000 Patients)

Zeinab Aly Moussa Aly
Ain Shams University Hospital, Cairo, Egypt
,
Karim Abd El Tawab
Ain Shams University Hospital, Cairo, Egypt
› Author Affiliations

Background: Central venous (CV) access is mandatory in pediatric and neonatal Intensive Care Unit (ICU) allowing resuscitation for intravascular fluid and various medication injections as well as a mean for hemodynamic monitoring. Jugular vein catheterization is the most common central vein accessed followed by the femoral which is despite being safer carries higher incidence of thromboembolic and infectious complications. The ultrasound guidance can both increase the success rate and decrease the procedure-related complications. Methods: From March 2014 to November 2017, ultrasound-guided CV line (CVL) was applied in 1016 patients in the Ain Shams University Hospitals' ICU (median age: 3 months [0–24] months), neonates 0–28 days (n = 423), and pediatrics below 24 months (n = 539). The sites of cannulation were the right internal jugular vein (IJV) in 65.3% of the patients, left IJV in 23.2%, right femoral vein in 7.9%, and left femoral in 3.5%. Interventional radiology residents on duty applied 3, 4, or 5F double lumen CV catheter according to patient's age and weight under local anesthesia. Under transverse view 10 MHz ultrasound transducer, Doppler was done to identify the vein from the adjacent artery whether carotid or femoral; after proper sterilization, the transducer center was placed over the center of the vein. Cannulation is then performed using classic Seldinger technique. Results: Cannulation was successful in 98.2% of cases. Right IJV was always attempted first followed by left IJV followed by either femoral with no preference. There was no significant difference in technical success between the two groups. Carotid puncture happened in nine cases, eight neonates, and one pediatric patient in whom the catheter was applied to the artery and developed a transient ischemic attack after antibiotic injection to the artery which resolved spontaneously. One case developed hemopneumothorax treated by chest tube application and also resolved. Conclusion: Ultrasound-guided CV line is rather safe and feasible compared with published series on blind technique with higher overall success and a lower rate of complications.



Publication History

Article published online:
11 May 2021

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