title: Ultrasound-guided central venous cannulation in infants weighing less than 5 kilograms.
abstract: OBJECTIVE
  Recent reports suggest that ultrasound-guided central venous cannulation may also be safe and effective in infants. This study aimed to evaluate the success and complications rate of this technique in infants weighing less than 5 kg.
  
  
  METHODS
  We studied 45 infants, weighing less than 5 kg (mean weight: 2.9 ± 1.1 kg, median: 3.1) needing a central venous access for intensive care treatment. In all patients, venous access was obtained by ultrasound-guided cannulation of the internal jugular vein (IJV).
  
  
  RESULTS
  Central venous cannulation was successful in all 45 infants. The right internal jugular vein (IJV) was used in most cases (92%). The IJV was antero-lateral to the carotid artery in 66% of patients, lateral in 28% and anterior in 6%. Although we recorded 10 complications (22.2%), only one was clinically relevant (one pneumothorax). The other complications were repeated venipunctures (n=4), kinking of the guidewire (n=3) and local venous hematomas (n=2). The time required for completing the procedure was 7 ± 4.3 min, while the mean time of central venous catheter permanence was 5.5 ± 8 days. There was a negative correlation between the patient's weight and the time needed for cannulation (p<0.01). Complications occurred in infants with a lower body weight (p<0.01).
  
  
  CONCLUSIONS
  Our experience suggests that ultrasound-guided central vein cannulation can be performed by well-trained physicians in infants weighing less than 5 kg without relevant risks.
authors.affiliation: Department of Emergency, Anesthesia and Intensive Care, Children's Hospital Bambino Gesù, Rome, Italy. matteo.dinardo@tin.it
authors.forename: Matteo
authors.initials: M
authors.lastname: Di Nardo
authors.forename: Caterina
authors.initials: C
authors.lastname: Tomasello
authors.forename: Mauro
authors.initials: M
authors.lastname: Pittiruti
authors.forename: Daniela
authors.initials: D
authors.lastname: Perrotta
authors.forename: Marco
authors.initials: M
authors.lastname: Marano
authors.forename: Corrado
authors.initials: C
authors.lastname: Cecchetti
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Pasotti
authors.forename: Nicola
authors.initials: N
authors.lastname: Pirozzi
authors.forename: Francesca
authors.initials: F
authors.lastname: Stoppa
mesh_terms: D001835:Body Weight; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007558:Italy; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D018579:Patient Selection; D015641:Radiography, Interventional; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014463:Ultrasonography