title: Comparison of ultrasound guided brachiocephalic and internal jugular vein cannulation in critically ill children.
abstract: To determine whether ultrasound (US)-guided longitudinal in-plane supraclavicular cannulation of the brachiocephalic vein (BCV) improves cannulation success rates compared to transverse out-of-plane internal jugular vein (IJV) cannulation in urgent insertion of temporary central venous catheters (CVC) in critically ill children.
  
  
  
  Prospective open pilot (non-randomized) comparative study carried out in a pediatric intensive care unit (PICU) of a university-affiliated hospital. Newborns and children aged 0 to 14 years admitted to the PICU in whom an urgent CVC was clinically indicated and was inserted in the IJV or BCV by US guidance were eligible. First-attempt success rate, overall success rate, number of puncture attempts, and cannulation time were compared between IJV and BCV techniques.
  
  
  
  Forty-six procedures (24 IJV and 22 BCV) in 38 patients were included. Full-sample median (range) age and weight were 13 (0.6-160) months and 9.5 (0.94-50) kg. No significant differences between IJV and BCV groups were observed for sex, age, weight, admission diagnosis, intra-procedural mechanical ventilation and sedation protocol. First attempt success rate was higher in the BCV than the IJV group (73 vs 37.5%, P= .017). Overall success rate was slightly higher in the BCV group (95 vs 83%, P = nonsignificant). Median (range) number of cannulation attempts [1 (1-3) vs 2 (1-4)] and cannulation time [66 (25-300) vs 170 (40-500) seconds] were significantly lower in the BCV group (P< .05). Patient's weight was inversely related to the number of cannulation attempts (Pearson coefficient -0.537, P= .007) and cannulation time (Pearson coefficient -0.495, P= .014) in the IJV but not in the BCV group. No major complications were observed.
  
  
  
  Ultrasound-guided supraclavicular in-plane BCV cannulation improved first attempt CVC cannulation success rates and reduced puncture attempts and cannulation time compared to US-guided out-of-plane IJV in critically ill children. A large randomized clinical trial is warranted to confirm our results.
authors.affiliation: Pediatric Critical Care Unit, Complejo Asistencial Universitario de León, Spain; Institute of Biomedicine of Leon (IBIOMED), University of León, Spain; Working Group on Bedside Ultrasound of the Spanish Society of Pediatric Critical Care (SECIP). Electronic address: ignacio.oulego@gmail.com.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Oulego-Erroz
authors.affiliation: Department of Pediatrics, Complejo Asistencial Universitario de León, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Muñoz-Lozón
authors.affiliation: Department of Pediatrics, Complejo Asistencial Universitario de León, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Alonso-Quintela
authors.affiliation: Pediatric Emergency and Critical Care Division, Clinical University Hospital, University of Santiago de Compostela, Spain; Institute of Investigation of Santiago (IDIS), Santiago de Compostela, Spain; Research Network on Maternal and Child Health and Development II (Red SAMID II), Spanish Health Institute Carlos III, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rodríguez-Nuñez
mesh_terms: D000293:Adolescent; D000758:Anesthesia / Q000379:methods; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging*; D002405:Catheterization, Central Venous / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D010372:Pediatrics / Q000379:methods; D010865:Pilot Projects; D011446:Prospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: Brachiocephalic vein; Central venous catheter; Internal jugular vein; Pediatric intensive care unit; Ultrasound