title: A novel skin-traction method is effective for real-time ultrasound-guided internal jugular vein catheterization in infants and neonates weighing less than 5 kilograms.
abstract: BACKGROUND
  Internal jugular vein (IJV) catheterization in pediatric patients is sometimes difficult because of the small sizes of veins and their collapse during catheterization. To facilitate IJV catheterization, we developed a novel skin-traction method (STM), in which the point of puncture of the skin over the IJV is stretched upward with tape during catheterization. In this study, we examined whether the STM increases the cross-sectional area of the vein and thus facilitates catheterization.
  
  
  METHODS
  This was a prospective study conducted from December 2006 to June 2008. We enrolled 28 consecutive infants and neonates weighing <5 kg who underwent surgery for congenital heart disease. The patients were randomly assigned to a group in which STM was performed (STM group) or a group in which it was not performed (non-STM group). The cross-sectional area and diameter of the right IJV in the flat position and 10 degrees Trendelenburg position with and without applying STM were measured. We determined time from first skin puncture to the following: (a) first blood back flow, (b) insertion of guidewire, and (c) insertion of catheter. Number of punctures, success rate, complications, and degree of IJV collapse during advancement of the needle (estimated as decrease of anteroposterior diameter during advancement of the needle compared with the diameter before advancement) were also examined.
  
  
  RESULTS
  STM significantly increased the cross-sectional area and the anteroposterior diameter of the IJV in both positions. The time required to insert the catheter was significantly shorter in the STM group, probably mainly due to a shorter guidewire insertion time. The degree of IJV collapse during advancement of the needle was much lower in the STM group.
  
  
  CONCLUSIONS
  STM facilitates IJV catheterization in infants and neonates weighing <5 kg by enlarging the IJV and preventing vein collapse.
authors.affiliation: Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, Nagoya City, Aichi, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Morita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sasano
authors.forename: Takafumi
authors.initials: T
authors.lastname: Azami
authors.forename: Nobuko
authors.initials: N
authors.lastname: Sasano
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Fujita
authors.forename: Shoji
authors.initials: S
authors.lastname: Ito
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sugiura
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sobue
mesh_terms: D000776:Anesthesiology / Q000379:methods; D002405:Catheterization, Central Venous / Q000379:methods*; D005260:Female; D006331:Heart Diseases / Q000151:congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007601:Jugular Veins / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D008297:Male; D011446:Prospective Studies; D012867:Skin; D014143:Traction / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*