Ultrasound-guided internal jugular catheterisation in paediatric cardiac surgical patients: a prospective observational study

Background
Obtaining central venous access in paediatric patients is challenging and failure rates range from 5 to 19%. Ultrasound guidance has been newly introduced to our resource-limited set-up, and our aim was to evaluate the success rate during internal jugular catheterization in paediatric cardiac surgical patients.
Patients and methods
Over a period of 6 months, 106 consecutive paediatric patients scheduled for cardiac surgery requiring cannulation of the right internal jugular vein were enrolled in the study. The outcome measure was to find out the correlating factors for the number of attempts required and the rate of complications along with the success rate and time taken for successful cannulation.
Results
The overall success rate was 100% with a rate of successful catheterization in the first attempt being 76.41% [95% confidence interval (95% CI): 68.33–84.49]; second attempt was required in 16.98% (95% CI: 9.83–24.13) and the third attempt in 5.66% (95% CI: 1.26–10.06). The mean number of attempts for successful cannulation was 1.29±0.59. The mean time from skin prick to blood aspiration after successful cannulation was 134.06±81.59 s. The overall complication was 10.4% (95% CI: 4.59–16.21) among which arterial puncture and haematoma formation was seen in all 11 cases; pneumothorax and haemothorax were seen in one (0.9%) of those patients The number of attempts required showed weak negative correlation with age, height, body weight, body surface area and cross-sectional area.
Conclusion
Ultrasound guidance for central venous cannulation in paediatric patients has acceptable success rates. Arterial puncture with haematoma formation is the most common complication. The overall complication rate is directly related to the number of pricks.