Ultrasound evaluation of techniques for internal jugular vein puncture in children.
OBJECTIVE
To determine by ultrasound which access and position the child must stay to obtain the best transversal section of the right Internal Jugular Vein (RIJV) allowing a safer puncture.


METHODS
Three possible accesses to the RIJV, anterior, lateral and posterior, from 57 healthy children, were analyzed through ultrasound images in a sequence of positions of the head, in supine position, with or without a roll under the scapula: head centered in neutral position with and without a roll (NPP and NP); contra lateral rotation with and without a roll (CLRP and CLR), neutral position and the patient raised in 30 degrees in Trendelenburg position (TDG). To analyze the results it was applied one statistic method, with variation analysis to the same individuals.


METHODS
Ultrasound evaluation in each one of the proposed positions.


RESULTS
The statistical analysis of the results observed that the lateral puncture with the patient in the neutral position, in Trendelemburg without a roll, offers a bigger area in comparison to all the other options of puncture and positioning of the patient (p<0, 0001).


CONCLUSIONS
The safer way for the puncture of RIJV in children is obtained in neutral position in Trendelemburg by lateral puncture, without a shoulder roll.
Schettini
Sérgio Tomaz
ST
Division of Pediatric Surgery, Department of Surgery, UNIFESP, Brazil. stschettini@uol.com.br
Oliveira
Luiz Fernando Ybarra Martins de
LF
Henao
Harold Ruiz
HR
Lederman
Henrique Manoel
HM
D000293:Adolescent; D002406:Catheterization, Peripheral / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D011677:Punctures / Q000379:methods*; D018084:Ultrasonography, Interventional