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.
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.