Complications of 1309 internal jugular vein cannulations with the anatomic landmarks technique in infants and children.
OBJECTIVE
Report the procedural complications of internal jugular vein (IJV) catheter insertion in infants and children and discuss how to prevent them.


METHODS
An observational study was performed from January 2006 to August 2010; 1309 internal jugular vein cannulae were inserted in the operating room by either staff or resident anesthesiologists. Patient age, weight, sex, type of catheter (diameter, lumen number), number of attempts, and complications were recorded. The discussion is focused on how to prevent or reduce internal jugular vein line insertion related complications in infants and children.


RESULTS
1309 IJV cannulae were inserted, 85.63% of catheters placed were successful after one to three attempts. Complications included 12 arrhythmias (0.91%), 25 arterial punctures (1.90%), 16 hematomas (1.22%), 17 device occlusions, breaks or malpositions (1.29%), 11 line-related infections (0.84%), four cases of thrombus (0.31%), two cardiopulmonary arrests (0.15%), two hemothoraces (0.15%), five pneumothoraces (0.38%), and one guidewire winding (0.07%). The complication rates of resident anesthesiologists were significantly higher compared to staff anesthesiologists for both common and rare complications (4.27% versus 2.21%; 0.68% versus 0.07%, respectively). In addition, residents' number of attempts were greater than staff anesthesiologists (1.84 and 1.38, respectively).


CONCLUSIONS
The IJV catheterization was feasible in infants and children. To reduce the risk of complications, the procedure should be performed or supervised by staff anesthesiologists; inserting the needle, guidewire, dilator, and the catheter too far should be avoided. It is now commonly accepted that all central venous cannulations should be performed under ultrasound guidance, especially in children.
Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, China.
Shengfen
S
Tu
Xiaoyi
X
Wang
Lin
L
Bai
Hong
H
Wang
Mao
M
Ye
Yuan
Y
Shi
Shengde
S
Wu
Xing
X
Liu
Guanghui
G
Wei
D000367:Age Factors; D059925:Anatomic Landmarks; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007396:Internship and Residency; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008297:Male; D008505:Medical Staff, Hospital; D018570:Risk Assessment; D012307:Risk Factors; D018084:Ultrasonography, Interventional