title: Percutaneous central venous catheterization through the external jugular vein in children: is inserting the guide wire into the superior vena cava essential for successful catheterization?
abstract: OBJECTIVE
  The external jugular vein (EJV) is an attractive alternative for percutaneous central venous catheterization (PCVC), with fewer complications. The inability to pass the guide wire into the superior vena cava (SVC) is, however, a major reason for the failure of this approach. The authors report a modification of the Seldinger technique to increase the effectiveness of this procedure in children.
  
  
  METHODS
  Between May 2008 and June 2009, we performed 100 PCVCs consecutively in children using the Seldinger technique through the EJV (Step 1). In cases in which the guide wire could not be passed into the SVC, the guide wire was kept in the EJV; and only the catheter was introduced into the central venous position (Step 2). Differences between the standard and modified Seldinger techniques were analyzed.
  
  
  RESULTS
  The procedure with the standard Seldinger technique (Step 1) was successful in 13 (13%) out of 100 patients. In 84 (96.5%) of the 87 remaining patients, PCVC was achieved with the modified Seldinger technique, without the insertion of the guide wire until the SVC (Step 2). Altogether, 97 catheters (97%) were successfully inserted, with 85 (87.6%) correctly positioned in the SVC. In addition, there were 7 (7%) clinically irrelevant hematomas during catheterization.
  
  
  CONCLUSIONS
  The EJV is an excellent alternative anatomical location for the completion of PCVC in children. Placing the guide wire in a central position is not essential to the success rate of this approach. The proposed modified Seldinger technique allowed PCVC to be performed through the EJV safely and with a high success rate in children and adolescents.
authors.affiliation: Department of Surgery, Federal University of Minas Gerais Medical School, Belo Horizonte, MG, Brasil. cruzeirop@hotmail.com
authors.forename: Paulo Custódio F
authors.initials: PC
authors.lastname: Cruzeiro
authors.forename: Paulo Augusto M
authors.initials: PA
authors.lastname: Camargos
authors.forename: Edson S
authors.initials: ES
authors.lastname: Tatsuo
authors.forename: Clécio
authors.initials: C
authors.lastname: Piçarro
authors.forename: Bernardo A
authors.initials: BA
authors.lastname: Campos
authors.forename: Ricardo M
authors.initials: RM
authors.lastname: Paixão
authors.forename: Andrey K
authors.initials: AK
authors.lastname: Pontes
authors.forename: Carlos Renato O
authors.initials: CR
authors.lastname: Teixeira
authors.forename: Marcelo E
authors.initials: ME
authors.lastname: Miranda
mesh_terms: D000293:Adolescent; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007601:Jugular Veins; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D014683:Vena Cava, Superior