A randomized trial of ultrasound image-based skin surface marking versus real-time ultrasound-guided internal jugular vein catheterization in infants.
BACKGROUND
Ultrasound-guided central venous catheterization has been recommended to increase the procedural success rate and enhance patient safety. However, few studies have examined the potential advantages of one ultrasound technique with another, specifically in small infants.


METHODS
The authors randomly assigned 60 neonates and infants weighing less than 7.5 kg to an ultrasound-guided skin-marking method (n = 27) versus real-time ultrasound-assisted internal jugular venous catheterization (n = 33). The times to successful puncture of the internal jugular vein and to catheterization were measured. Attempts at needle punctures for successful catheterization were counted. Procedural complications were recorded.


RESULTS
In the real-time group, compared with the skin- marking group, venous puncture was completed faster (P = 0.03), the time required to catheterize was shorter (P < 0.01), and fewer needle passes were needed. Specifically, fewer than three attempts at puncture were made in 100% of patients in the real-time group, versus 74% of patients in the skin-marking group (P < 0.01). A hematoma and an arterial puncture occurred in one patient each in the skin-marking group.


CONCLUSIONS
The real-time ultrasound guidance method could enhance procedural efficacy and safety of internal jugular catheterization in neonates and infants.
Hosokawa
Koji
K
Department of Anesthesiology, University Hospital, Kyoto Prefectural School of Medicine, Kyoto, Japan.
Shime
Nobuaki
N
Kato
Yuko
Y
Hashimoto
Satoru
S
D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007430:Intraoperative Care / Q000379:methods / Q000706:statistics & numerical data; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D011446:Prospective Studies; D011677:Punctures / Q000009:adverse effects / Q000706:statistics & numerical data; D012449:Safety; D012867:Skin; D013997:Time Factors; D014463:Ultrasonography / Q000379:methods*