title: Ultrasound-guided internal jugular venous cannulation in infants: a prospective comparison with the traditional palpation method.
abstract: BACKGROUND
  Percutaneous cannulation of the internal jugular vein in infants is technically more difficult and carries a higher risk of carotid artery puncture than in older children and adults. In this prospective study, the authors tested their hypothesis that using an ultrasound scanner would increase the success of internal jugular cannulation and decrease the incidence of carotid artery puncture in infants.
  
  
  METHODS
  After approval from the institutional review board and receipt of written informed parental consent, 95 infants scheduled for cardiac surgery were randomized prospectively into two groups. In the landmarks group, the patients' internal jugular veins were cannulated using the traditional method of palpation of carotid pulsation and identification of other anatomic landmarks. In the ultrasound group, cannulation was guided using an ultrasound scanner image. The cannulation time, number of attempts, success rate, and incidence of complications were compared for the two groups.
  
  
  RESULTS
  There were no significant differences between the two groups with regard to weight, age, and American Society of Anesthesiologists physical status classification. The success rate was 100% in the ultrasound group, with no carotid artery punctures, and 77% in the landmarks group, with a 25% incidence of carotid artery punctures. Both differences were significant (P > 0.0004). The cannulation time was less, the number of attempts was fewer, and the failure rate was significantly lower in the ultrasound group than in the landmark group.
  
  
  CONCLUSIONS
  Ultrasonographic localization of the internal jugular vein was superior to the landmarks technique in terms of overall success, speed, and decreased incidence of carotid artery puncture.
authors.affiliation: Department of Anesthesiology, Children's National Medical Center and George Washington University, Washington, DC 20010, USA. sverghes@cnmc.org
authors.forename: S T
authors.initials: ST
authors.lastname: Verghese
authors.forename: W A
authors.initials: WA
authors.lastname: McGill
authors.forename: R I
authors.initials: RI
authors.lastname: Patel
authors.forename: J E
authors.initials: JE
authors.lastname: Sell
authors.forename: F M
authors.initials: FM
authors.lastname: Midgley
authors.forename: U E
authors.initials: UE
authors.lastname: Ruttimann
mesh_terms: D020212:Carotid Artery Injuries; D002405:Catheterization, Central Venous / Q000191:economics / Q000379:methods*; D003365:Costs and Cost Analysis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007601:Jugular Veins; D010173:Palpation; D011446:Prospective Studies; D014463:Ultrasonography