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Ultrasound guided jugular vein catheterization in premature newborns

"Rapid central venous catheterization is critical for the rescue and perioperative management of premature infants requiring surgery" Liu et al (2020).

Abstract:

Background: Rapid central venous catheterization is critical for the rescue and perioperative management of premature infants requiring surgery. Ultrasound-guided dynamic needle tip positioning (DNTP) has been widely used as a very effective technique, especially in paediatric vascular puncture and catheterization. However, for low-weight premature newborns, central vein catheterization still poses greater difficulties for paediatricians and paediatric anaesthesiologists. This prospective randomized control study aimed to evaluate the efficacy of combined short- and long-axis (CSLA) internal jugular vein catheterization for premature newborns in comparison with the DNTP technique.

Methods: A total of 90 premature newborns (gestational age <37 weeks and <28 d after birth) who were scheduled for surgery were included in this study. All enrolled premature newborns were randomly divided into two groups (n=45): the CSLA group and the DNTP group. We compared the first-puncture success rate, total success rate, procedure time, number of needle passes, occurrence of complications and other outcome measures between the two groups.

Results: The two groups (n=45 per group) were similar in sex, gestational age, weight, mean arterial blood pressure, and vein-related measurements of the internal jugular vein. Total success was achieved in 43 (95.6%) and 36 (80.0%) patients in the CSLA and DNTP groups, respectively. Compared with the DNTP group, the CSLA group showed a significantly higher first-attempt success rate (71.1% vs. 46.7%, χ2 =5.5533, P=0.0184) and significantly fewer needle passes (1.0[1.0-2.0] vs. 2.0[1.0-3.0], χ2 =-2.6094, P=0.0091). There was no significant difference between the groups in the procedure time (368[304-573] vs. 478[324-79]s, Z=-1.7690, P=0.0769). Complications occurred in both groups, but the incidence was significantly lower in the CSLA group than in the DNTP group (6.7% vs. 22.2%, χ2 =4.4056, P=0.0358).

Conclusions: Ultrasound-guided internal jugular vein catheterization by the CSLA method is effective and safe. The CSLA method may be superior to the DNTP technique in premature newborns.

Reference:

Liu W, Tu Z, Liu L, Tan Y. Combined short- and long-axis method for internal jugular vein catheterization in premature newborns: A randomized controlled trial. Acta Anaesthesiol Scand. 2020 Nov 4. doi: 10.1111/aas.13728. Epub ahead of print. PMID: 33147353.