ORIGINAL ARTICLE: Ultrasonographic evaluation of the femoral vein in anaesthetised infants and young children

Abstract

SummaryWe investigated the cross-sectional area of the femoral vein and its relationship to the femoral artery at two anatomical levels, in infants and children. Sixty-six subjects were allocated to one of two groups: infants (< 1 year, n = 31) or children (1-6 years, n = 35). After induction of general anaesthesia, the femoral vein was evaluated by ultrasound with the patients' legs at 30°and 60°of abduction and their hips externally rotated. In each position, measurements were taken at the level of the inguinal crease and 1 cm below the crease. Hip rotation with 60°leg abduction decreased femoral artery overlap at the level of the inguinal crease in both infants (p = 0.013) and children (p = 0.003). Thus, the optimal place for femoral vein cannulation in paediatric patients seems to be at the level of the inguinal crease with 60°leg abduction and external hip rotation.

Ultrasound-guided vascular cannulation. Experience in critically-ill pediatric patients

“…28 Most complications are associated to the multiple attempts to puncture the vessel with the needle to achieve cannulation. 14,27,29,30 The risk of complications significantly increases after two punctures of the same vessel, 28 and this increase is six times higher after three attempts. 30 Likewise, Ueda et al 31 conclude that a larger diameter is significantly associated to the success rate of a first attempt.…”

“…The same happens with cervical vessels, since the internal carotid artery can overlap the IJV or present these anatomical variations in relation to the internal carotid artery in as much as 54% of cases. 27 In comparison with the standard technique which uses anatomical landmarks, the use of ultrasound to cannulate central vessels in children reduces the number of attempts resulting in a lower complication rate. 28 Most complications are associated to the multiple attempts to puncture the vessel with the needle to achieve cannulation.…”

Canalización vascular ecoguiada. Experiencia en el paciente pediátrico crítico

“…[6][7][8][9] Iwashima et al, 25 citaron que la punción accidental de la AF ocurría en un 7% de los pacientes pediátricos cuando se utilizaba la ecografía, en relación con un 32% al hacerlo según la referencia anatómica. Esta tasa tan alta de punción arterial puede deberse, como apunta otro estudio realizado por Suk et al, 26 a las variaciones anatómicas que presentan los vasos, que pueden llegar a una tasa de superposición entre la arteria y la vena femoral en los niños de hasta un 74%. Igualmente ocurre en los vasos cervicales, ya que la arteria carótida interna puede superponerse a la VYI o presentar estas variantes anatómicas en su relación con la arteria carótida interna de hasta un 54%.…”

Comparison of ultrasound-guided vs. anatomical landmark-guided cannulation of the femoral vein at the optimum position in infant

“…However, studies have clearly shown that US-guided femoral vein cannulation can result in shorter cannulation times, than anatomical landmark-based cannulation. 4 The most common complication during femoral vein cannulation is femoral artery puncture, which may lead to arteriovenous fistula, pseudoaneurysm, hematoma, arterial thrombosis or peripheral embolism. 3 Moreover, pricking of the head of the femur may lead to avascular necrosis.…”

“…In this position, the cross-sectional area of the femoral vein is larger, and femoral artery overlapping is minimal. 4 The study was undertaken to evaluate whether US-guided femoral vein cannulation resulted in higher success rates…”