Computer-assisted needle navigation for pediatric internal jugular central venous cannulation: A feasibility study

Abstract

Introduction: Vascular access for central venous catheter placement is technically challenging in children. Ultrasound guidance is recommended for pediatric central venous catheter placement, yet many practitioners rely on imprecise anatomic landmark techniques risking procedure failure due to difficulty mastering ultrasound guidance. A novel navigation system provides a visual overlay on real-time ultrasound images to depict needle trajectory and tip location during cannulation. We report the first pediatric study assessing feasibility and preliminary safety of using a computer-assisted needle navigation system to aid in central venous access. Methods: A prospective, institutional review board–approved feasibility study was performed. All participants provided written informed consent. Ten patients (mean age: 11.4 years, five males) underwent central venous catheter placement with ultrasound and navigation system guidance. All procedures were performed by interventional radiologists expert in vascular access. Feasibility was measured through binary (yes/no) responses from participating users assessing device usability and feasibility. The number of needle passes and procedure time measures were also recorded. Results: Internal jugular veins (seven right sided, three left sided) were cannulated in all patients with no complications. Users confirmed navigation system feasibility in all 10 participants. Mean vein diameter and depth was 13.3 × 9.8 ± 3.4 × 2.1 and 7.0 ± 1.7 mm, respectively. Successful cannulation occurred in all patients and required only a single needle pass in 9 of 10 patients. Mean device set-up and vascular access times were 5:31 ± 2:28 and 1:48 ± 2:35 min, respectively. Conclusion: This pilot study suggests that it is feasible to use a novel computer-assisted needle navigation system to safely obtain central venous access under ultrasound guidance in pediatric patients.

Improvement of central vein ultrasound-guided puncture success using a homemade needle guide—a simulation study

“…However, IP approach requires accurate needle alignment with the ultrasound beam making this approach highly demanding. Needle guiding devices or methods to facilitate IP approach are available but tend to be expensive (several hundred €), sometimes specific to particular probes, and remain poorly investigated so far [8][9][10][11][12][13].…”

The Right Internal Jugular at the Cricoid Cartilage Level May Represent the Optimal Central Vein Puncture Site in Pediatric Patients

“…Prior to the use ultrasonography guidance for central venous catheterization, the prevailing technique for this procedure is based on locations of different anatomical landmarks and not direct visualization of the target vein and its ambient structures. Given anatomical differences in children and adults and because veins of pediatric patients are much smaller and more mobile than those of adults ( 3 ), they are at higher risk of maneuvering-related complications ( 4 ). With the development of ultrasound (US) techniques and devices, US visualization guidance is commonly recommended in central venous catheter placement, especially in pediatric patients ( 5 ), given its reduction in complications and improvement in the success rate.…”