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Original article
Ultrasound guidance for internal jugular vein cannulation in PICU: a randomised controlled trial
  1. Tiago Henrique de Souza1,
  2. Marcelo Barciela Brandão1,
  3. Thiago Martins Santos2,
  4. Ricardo Mendes Pereira1,
  5. Roberto José Negrão Nogueira1,3
  1. 1 Deparment of Pediatrics, University of Campinas (UNICAMP), Campinas, Brazil
  2. 2 Deparment of Emergency Medicine, University of Campinas (UNICAMP), Campinas, Brazil
  3. 3 Department of Pediatrics, School of Medicine São Leopoldo Mandic, Campinas, Brazil
  1. Correspondence to Dr Tiago Henrique de Souza, Division of Critical Care, Department of Pediatrics, University of Campinas (UNICAMP), Campinas, SP 13083-887, Brazil; tiago.souza{at}hc.unicamp.br

Abstract

Objective We investigated whether ultrasound guidance was advantageous over the anatomical landmark technique when performed by inexperienced paediatricians.

Design Randomised controlled trial.

Setting A paediatric intensive care unit of a teaching hospital.

Patients 80 children (aged 28 days to <14 years).

Interventions Internal jugular vein cannulation with ultrasound guidance in real time or the anatomical landmark technique.

Main outcome measures Success rate, success rate on the first attempt, success rate within three attempts, puncture time, number of attempts required for success and occurrence of complications.

Results We found a higher success rate in the ultrasound guidance than in the control group (95% vs 61%, respectively; p<0.001; relative risk (RR)=0.64, 95% CI (CI) 0.50 to 0.83). Success on the first attempt was seen in 95% and 34% of venous punctures in the US guidance and control groups, respectively (p<0.001; RR=0.35, 95% CI 0.23 to 0.54). Fewer than three attempts were required to achieve success in 95% of patients in the US guidance group but only 44% in the control group (p<0.001; RR=0.46, 95% CI 0.32 to 0.66). Haematomas, inadvertent arterial punctures, the number of attempts and the puncture time were all significantly lower in the ultrasound guidance than in the control group (p<0.015 for all).

Conclusions Critically ill children may benefit from the ultrasound guidance for internal jugular cannulation, even when the procedure is performed by operators with limited experience.

Trial registration number RBR-4t35tk.

  • intensive care
  • procedures
  • central venous catheterization
  • ultrasonography
  • jugular vein

http://dx.doi.org/10.1136/archdischild-2017-314568

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    Footnotes

    • Contributors THdS, MBB and RMP conceptualised and designed the study and data collection instruments, coordinated and supervised data collection. THdS, TMS and RJNN wrote the manuscript and analysed data. RJNN revised the manuscript. All authors approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Research Ethics Committee of the University of Campinas (registration number 38170714.9.0000.5404).

    • Provenance and peer review Not commissioned; externally peer reviewed.