title: Comparison of landmark technique and ultrasound guidance for localisation of long saphenous vein in infants and children.
abstract: OBJECTIVE
  The long saphenous vein (LSV) is commonly used in small children to obtain venous access, and is usually cannulated at the ankle using the anatomical landmark technique. This is a 'blind' technique, which frequently requires multiple attempts, and may be associated with complications and failure. This study compared ultrasound guidance and landmark technique for localisation of the LSV in infants and small children.
  
  
  METHODS
  40 children aged 6 months to 2 years scheduled for elective surgery were included in this prospective clinical observational study. The anticipated puncture site of the LSV at the ankle was marked by either a consultant paediatric anaesthetist or a trainee anaesthetist using anatomical landmarks. A Sono-site Micromaxx 13-6 MHz SLA transducer was then used to determine the distance between the mark and the LSV. The diameter of the LSV was also measured.
  
  
  RESULTS
  Mean LSV diameters were 2.60+/-0.68 mm and not significantly different between consultant and trainee groups (p=0.34). The mean distance of the anticipated puncture site from the middle of the vein was 3.14 mm (+/- 2.78 mm). The use of anatomical landmarks would have resulted in failure to cannulate the LSV in 58 of 79 (73%) attempts. Consultant anaesthetists were more likely to be successful (14 of 42 (33%) attempts, mean distance from LSV 2.6+/-2.6 mm) when compared with trainees (8 of 37 attempts (22%), mean distance from LSV 3.7+/-2.9 mm, p=0.034).
  
  
  CONCLUSIONS
  Ultrasound guidance is superior to the anatomical landmark technique for localisation of LSV and may reduce the number of cannulation attempts in infants and small children.
authors.affiliation: Department of Paediatric Anaesthesia, Royal Aberdeen Children's Hospital, Foresterhill, Aberdeen, UK. mandarjoshi@nhs.net
authors.forename: Mandar
authors.initials: M
authors.lastname: Joshi
authors.forename: Graham
authors.initials: G
authors.lastname: Wilson
authors.forename: Thomas
authors.initials: T
authors.lastname: Engelhardt
mesh_terms: D002406:Catheterization, Peripheral / Q000379:methods*; D002675:Child, Preschool; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007223:Infant; D019370:Observation; D011446:Prospective Studies; D012501:Saphenous Vein / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D014463:Ultrasonography