INTRODUCTION hematothoraces is extremely low, in particular

Central venous catheter (CVC) placement is a commonly performed procedure for hemodynamic monitoring, fluid and antibiotic administration, total parenteral nutrition, and
hemodialysis 1. Common sites for CVC access include the internal jugular, subclavian, and femoral veins 2. CVC access has traditionally been achieved by visualizing or palpating anatomical landmarks 3. The carotid artery is palpated with one hand, then the skin is usually punctured at the level of the cricoid ring just lateral to the carotid artery. The needle is advanced at a 30-40° angle to the skin towards the ipsilateral nipple.4 The position of the IJV in relation to the carotid artery shows high variability.5 In the majority of the patients the IJV lies lateral to the carotid artery; as one moves more cranially it comes closer and sometimes even anterior to the carotid artery. In up to 5% the position might even be medial to the carotid artery.4 The major risk is accidental injury to the carotid artery. Very rarely, a haematoma causing tracheal compression can occur. Damage of the phrenic nerve is rare.The risk of causing pneumothorces or hematothoraces is extremely low, in particular when compared to the subclavian access. Malpositioning occurs more often when the left IJV is used. The guidewire may form a bow and end up in the right IJV.4 Although landmark (LM)-guided techniques have been associated with high levels of success, aberrant anatomy and previous catheterizations often complicate this procedure resulting in decreased success 3,6.

Ultrasound (US)-guided CVC insertion, first described in 1986 by Yonei et al., has been studied extensively and utilized in various settings .7 The current National Institute for Clinical Excellence (2002) recommendations state that US guidance is the preferred method for elective CVC insertion in both adults and children 8. While there is clear consensus on the benefits of US-guided CVC insertion in adults, existing evidence for similar benefit in US-guided CVC insertion in the pediatric population remains limited, controversial, or nonexistent 9  The aim of our study was to evaluate this method in a sample of pediatric cardiac patients ,success rate assessing the number of attempts, access time (skin to vein), incidence of complications, and the ease of use for central venous access in the neonates.

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Randolph AG, Cook DJ, Gonzales CA, Pribble CG. Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med 1996;24:2053–8.

Palepu GB, Deven J, Subrahmanyam M, Mohan S. Impact of ultrasonography on central venous catheter insertion in intensive care. Indian J Radiol Imaging 2009;19:191–8.

Troianos CA, Hartman GS, Glas KE, et al.; Councils on Intraoperative Echocardiography and Vascular Ultrasound of the American Society of Echocardiography; Society of Cardiovascular Anesthesiologists. Special articles: guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society Of Cardiovascular Anesthesiologists. Anesth Analg2012;114:46–72.

Central venous catheters in children and neonates (Part 2) – Access via the internal jugular vein U Trieschmann,1 M Kruessell,1  HYPERLINK “file:///C:pubmed?term=Cate%20Ut%5BAuthor%5D&cauthor=true&cauthor_uid=22368541” Udink ten F Cate,2 and N Sreeram2
Maecken T, Grau T. Ultrasound imaging in vascular access. Crit Care Med. 2007;35:S178–S185
McGee DC, Gould MK. Preventing complications of central venous catheterization.N Engl J Med 2003;348:1123–33.

National Institute for Clinical Excellence. Guidance on the use of ultrasound locating devices for placing central venous catheters. Technical Appraisal Guidance, 2002. guidance/ta49.

Grebenik CR, Boyce A, Sinclair ME, Evans RD, Mason DG, Martin B. NICE guidelines for central venous catheterization in children. Is the evidence base sufficient? Br J Anaesth 2004;92:827–30.

Wu SY, Ling Q, Cao LH, Wang J, Xu MX, Zeng WA. Real-time two dimensional ultrasound guidance for central venous cannulation: a meta-analysis. Anesthesiology 2013;118:361–75


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