Femoral vein cannulation performed by residents: a comparison between ultrasound-guided and landmark technique in infants and children undergoing cardiac surgery.
BACKGROUND
Percutaneous cannulation of the femoral vein, in the pediatric age group, can be technically challenging, especially when performed by residents in training. We examined whether the use of real-time ultrasound guidance is superior to a landmark technique for femoral vein catheterization in children undergoing heart surgery.


METHODS
Patients were prospectively randomized into 2 groups. In group LM, the femoral vein was cannulated using the traditional method of palpation of arterial pulse. In group US, cannulation was guided by real-time scanning with an ultrasound probe. The time to complete cannulation (primary outcome), success rate, number of needle passes, number of successful cannulations on first needle pass, and incidence of complications were compared between the 2 groups.


RESULTS
Forty-eight pediatric patients were studied. The time to complete cannulation was significantly shorter (155 [46-690] vs 370 [45-1620] seconds; P = 0.02) in group US versus group LM. The success rate was similar in both groups (95.8%). The number of needle passes was smaller (1 [1-8] vs 3 [1-21]; P = 0.001) and the number of successful cannulations on first needle pass higher (18 vs 6; P = 0.001) in group US compared with group LM. The incidence of femoral artery puncture was comparable between the 2 groups.


CONCLUSIONS
Ultrasound-guided cannulation of the femoral vein, in pediatric patients, when performed by senior anesthesia residents, is superior to the landmark technique in terms of speed and number of needle passes, with remarkable improvement in first attempt success.
Aouad
Marie T
MT
Department of Anesthesiology, American University of Beirut, P.O. Box 11-0236, Beirut, Lebanon.
Kanazi
Ghassan E
GE
Abdallah
Faraj W
FW
Moukaddem
Farah H
FH
Turbay
Massud J
MJ
Obeid
Mounir Y
MY
Siddik-Sayyid
Sahar M
SM
D006348:Cardiac Surgical Procedures; D002406:Catheterization, Peripheral / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D005268:Femoral Vein / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007396:Internship and Residency; D007866:Leg / Q000033:anatomy & histology; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography