Oblique Versus Transverse Orientation Approach for Internal Jugular Venous Cannulation in Pediatrics

Sixty patients randomised into two groups, 30 patients in experimental group (oblique orientation) and 30 patients in control group (transverse orientation). All cannulation took place in the operation room. Patients underwent general anesthesia and placed in supine position. Standard monitoring (electrocardiogram, non-invasive arterial pressure, pulseoxymetry) was carried out during the procedure for all patients. Before preparation of the skin, a pre-procedure ultrasound examination was performed to verify internal jugular vein patency, and its diameter was measured. Once the side had been chosen, the cannulation was performed following a sterile technique. All procedure were performed by Seldinger technique, with 22 Gauge IV catheter attached with 3 ml syringe as introducer needle. The vascular puncture was performed under ultrasound guidance, using a single-person technique. With transverse orientation, the transducer was placed transversally over the neck, and once the vein was visible in the middle of the ultrasound image, the needle was inserted in the plane perpendicular to the long axis of the transducer. With oblique orientation, the operator first obtained a transverse view of the vein and then rotated the transducer to 45 degrees (midway) between transverse and longitudinal view.

Inclusion criteria

• patients age 3 months to 12 years old, weight 5-20 kg, male or female
• who undergo heart surgery and indicated to have central venous cannulation
• American Society of Anesthesiologist Physical Class 1-3
• Family or representation of the patients agreed to participate in this study and sign informed consent

Exclusion criteria

• history of surgery in the area of cannulation
• already placed central venous cannulation <72 hours in the same venous
• sign of infection, hematoma, emphysema, in the area of cannulation
• history of cervical trauma
• severe hemostatic disorder (International Normalized Ratio>2, thrombocyte <50.000, Prothrombin time>1.5 times, Activated Partial Thromboplastin Time > 1.5 times