Ultrasonic analysis of the anatomical relationships between vertebral arteries and internal jugular veins in children

Abstract

BackgroundAccidental puncture of the vertebral arteries (VAs) can occur through the internal jugular veins (IJVs) during central venous catheterization (CVC). We evaluated the anatomic relation of the VAs to the IJVs in children undergoing IJV cannulation.MethodsFifty-five patients were placed in the supine position under general anesthesia. The right IJV, common carotid artery (CCA), and VA were described with an ultrasound probe perpendicular to all planes of the skin at the mid-portion between the suprasternal notch and mastoid process. The depth from the skin to VAs (D), width of the VAs (W), and distance from the IJVs to VAs (DIV) were measured. The extent of overlap between the IJVs and VAs was classified into overlapping, partially overlapping, and nonoverlapping. The risk was scored as 0–3 for each measurement. The scores were added and categorized into a low-risk group (L), 0–3, moderate-risk (M) group, 4–7; and high-risk (H) group, 8–10.ResultsMean (sd) age was 20.3 (33.9) months, height was 72.1 (26.0) cm, and weight was 8.9 (9.0) kg. The mean D, W, and DIV were 15.1 (3.3), 2.8 (1.1), and 4.6 (1.8) mm, respectively. Of the 55 patients, 7 were in group H, 33 in group M, and 15 in group L.ConclusionsSeven of the 55 children were categorized under the H group for accidental puncture of the VAs. Thus, it is important to identify the presence of the VAs to avoid accidental puncture during pediatric CVC.

Position and relative size of the vertebral artery according to age: Implications for internal jugular vein access

“…In our cohort with a similar body weight, the relative size of the VA to the IJV was greater (22.4% and 40.2% on the right and left sides, respectively, at the cricoid level) and the distance between the VA and IJV was greater (mean 6.0 mm in group 1) compared to those in the previous study. In another study performed in children with a mean age of 20.3 months, the distance between the VA and IJV was 4.6 (1.8) mm on the right side when evaluated using ultrasonography . The differences in the results between our study and these previous studies may have occurred because of the following reasons.…”

“…Overlapping between the VA and IJV can contribute to the risk of inadvertent VA puncture during IJV catheterization. According to previous studies, about 40%‐82% of pediatric patients showed full or partial overlap between the VA and IJV on the right side . In our study involving chest CT in children at the neutral position, full or partial overlap was observed in 52%‐78% of children.…”

Differences in anatomical relationship between vertebral artery and internal jugular vein in children and adults measured by ultrasonography

“…Several studies examined the anatomical relationship between CCA and IJV [8][9][10][11][12], but there are only a few between IJV and VA [13]. In the present study, VA was identified in all children at the level of the cricoid cartilage.…”

Ultrasound detection of guidewires in‐plane during pediatric central venous catheterization

“…An accidental vertebral arterial puncture was reported during central venous catheterization in a child undergoing ventricular septal defect repair . Vertebral arteries are seen behind the IJV to a certain extent . A 19.0‐mm‐long 24‐G puncture needle used in this study was advanced to a maximum depth of 9.5 or 16.0 mm, following insertion at 30 or 60 degree, respectively.…”