Ultrasound guidance for central vascular access in the neonatal and pediatric intensive care unit

Background: Percutaneous central venous cannulation (CVC) in infants and children is a challenging procedure, and it is usually achieved with a blinded, external landmark-guided technique. Recent guidelines from the National Institute for Clinical Excellence (NICE) recommend the use of ultrasound guidance for central venous catheterization in children. The purpose of this study was to evaluate this method in a pediatric and neonatal intensive care unit, assessing the number of attempts, access time (skin to vein), incidence of complication, and the ease of use for central venous access in the neonatal age group.

Methods: After approval by the local departmental ethical committee, we evaluated an ultrasound-guided method over a period of 6 months in 20 critically ill patients requiring central venous access in a pediatric intensive care unit and a neonatal intensive care unit (median age 9 (0-204) months and weight 9.3 (1.9-60) kg). Cannulation was performed after locating the puncture site with the aid of an ultrasound device (8 MHz transducer, Vividi General Electrics(®) Burroughs, USA) covered by a sterile sheath. Outcome measures included successful insertion rate, number of attempts, access time, and incidence of complications.

Results: Cannulation of the central vein was 100% successful in all patients. The right femoral vein was preferred in 60% of the cases. The vein was entered on the first attempt in 75% of all patients, and the median number of attempts was 1. The median access time (skin to vein) for all patients was 64.5 s. No arterial punctures or hematomas occurred using the ultrasound technique.

Conclusions: In a sample of critically ill patients from a pediatric and neonatal intensive care unit, ultrasound-guided CVC compared with published reports on traditional technique required fewer attempts and less time. It improved the overall success rate, minimized the occurrence of complications during vein cannulation and was easy to apply in neonatal and pediatric patients.