Ultrasound-guided central venous cannulation in low weight infants

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Intravenous literature: Di Nardo, M., Tomasello, C., Pittituti, M., Perrotta, D., Marano, M., Cecchetti, C., Pasotti, E., Pirozzi, N. and Stoppa, F. (2011) Ultrasound-guided central venous cannulation in infants weighing less than 5 kilograms. The Journal of Vascular Access. 12(4), p.321-324.

Abstract:

Purpose: Recent reports suggest that ultrasound-guided central venous cannulation may also be safe and effective in infants. This study aimed to evaluate the success and complications rate of this technique in infants weighing less than 5 kg.

Methods: We studied 45 infants, weighing less than 5 kg (mean weight: 2.9 ± 1.1 kg, median: 3.1) needing a central venous access for intensive care treatment. In all patients, venous access was obtained by ultrasound-guided cannulation of the internal jugular vein (IJV).

Results: Central venous cannulation was successful in all 45 infants. The right internal jugular vein (IJV) was used in most cases (92%). The IJV was antero-lateral to the carotid artery in 66% of patients, lateral in 28% and anterior in 6%. Although we recorded 10 complications (22.2%), only one was clinically relevant (one pneumothorax). The other complications were repeated venipunctures (n=4), kinking of the guidewire (n=3) and local venous hematomas (n=2). The time required for completing the procedure was 7 ± 4.3 min, while the mean time of central venous catheter permanence was 5.5 ± 8 days. There was a negative correlation between the patient’s weight and the time needed for cannulation (p<0.01). Complications occurred in infants with a lower body weight (p<0.01).

Conclusions: Our experience suggests that ultrasound-guided central vein cannulation can be performed by well-trained physicians in infants weighing less than 5 kg without relevant risks.

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