Ultrasound-guided femoral vein catheterization in neonates with cardiac disease*.
OBJECTIVE
To describe a novel technique for real-time, ultrasound-guided femoral vein catheterization in neonates with cardiac disease, and to compare it to a contemporaneous cohort of neonates undergoing femoral vein central venous line placement via landmark technique.


METHODS
Retrospective cohort study of data extracted from a quality improvement database.


METHODS
Pediatric cardiac intensive care unit and cardiovascular operating room in pediatric tertiary hospital.


METHODS
One hundred fifteen neonates (mean weight, 3.07 ± 0.41 kg) with cardiac disease who underwent femoral central venous line attempts from January 2009 to September 2011.


RESULTS
Study populations were similar in age, weight, and Risk Adjustment for Congenital Heart Surgery-1 category, but differed in intubation status (32% vs. 100%, ultrasound vs. landmark, p < .0001). Central venous line success rate was superior in the ultrasound group: 72 of the 76 (94.7%) vs. 31 of the 39 (79.5%), p = .02. Ultrasound group also had a superior first (75% vs. 30.8 %) and second attempt success rate (90.8% vs. 51.3%), p value for both < .0001. Inadvertent arterial puncture occurred less frequently in the ultrasound group: four of the 76 (5.3%) vs. nine of the 39 (23.1%), p = .01. There was a trend toward more venous thrombosis in the landmark group, 16 of the 39 (41%) vs. 18 of the 76 (23.7%), p = .08. Among all 115 subjects, there was a very strong association between greater than two central venous line attempts and the odds of being diagnosed with a deep venous thrombosis (odds ratio, 9.3; 95% confidence interval 3.5-24.8) and the odds of suffering an inadvertent femoral arterial puncture during the central venous line event (odds ratio, 8.8; 95% confidence interval 10.6-730).


CONCLUSIONS
This novel long-axis real-time ultrasound technique facilitates placement of femoral vein central venous line in critically ill neonates with cardiac disease at a higher rate of success with fewer attempts and lower occurrence of complications when compared with the landmark technique.
Division of Critical Care, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA. jalten@peds.uab.edu
Jeffrey A
JA
Alten
Santiago
S
Borasino
William Q
WQ
Gurley
Mark A
MA
Law
Rune
R
Toms
Robert J
RJ
Dabal
D059925:Anatomic Landmarks; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D016001:Confidence Intervals; D005268:Femoral Vein / Q000000981:diagnostic imaging* / Q000293:injuries; D006331:Heart Diseases / Q000151:congenital; D006801:Humans; D007231:Infant, Newborn; D016017:Odds Ratio; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D018084:Ultrasonography, Interventional; D057772:Vascular System Injuries / Q000209:etiology; D020246:Venous Thrombosis / Q000209:etiology