Ultrasound-guided supraclavicular approach to the subclavian vein in infants and children

Kulkarni, Vilas M; Mulavisala, K.P.; Mudunuri, Ravikiran; Byalal, J.R.

doi:10.1093/bja/aer428

Cited by 10 publications

(6 citation statements)

References 2 publications

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“…In these patients, placement in the left BCV was more common but both sides are reported as being used successfully (17,18). It may be helpful to scan both supraclavicular fossa pre-procedure to evaluate which side has the most complete visualisation of the arc of the subclavian/brachiocephalic confluence (7).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Cannulation of the Brachiocephalic Vein in Infants and Children is Useful and Stable

Thompson¹

2017

Turk J Anaesth Reanim

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Objective: Ultrasound-guided (USG) cannulation of the brachiocephalic vein (BCV) has been shown to be technically easy. We hypothesised that adoption of USG in-plane cannulation of the BCV as the primary approach to central venous cannulation at our institution would lead to central venous cannulation for a greater variety of indications. Methods:We performed retrospective, descriptive comparison of all central lines placed in patients aged <16 years who underwent any surgical operation during calendar years 2012-2014 at a small, free-standing children's hospital. The use and management of a central line was reviewed until the patient was discharged from the hospital. Analysis of the data was performed using simple comparative statistical methods. Results:Forty-nine patients were identified, 20 who weighed <10 kg and 29 who weighed >10 kg. Cannulation was successful in all patients. No significant late complications occurred. Catheters were well tolerated post-operatively, with no accidental dislodgement and no removal because of discomfort. The average duration of insertion was 6.3 (3-20±3.77) days. Nine catheters were placed for access during emergency surgery. 15 were placed in patients with difficult peripheral intravenous (PIV) access. The central lines remained in place until discharge in 79.6% of patients. In 40% of patients, the PIV catheter was removed, and the central line was retained because of preference. Total parenteral nutrition (TPN) was administered in 11 (22.4%) patients. Conclusion:Cannulation of BCV was well tolerated by children, with an average insertion duration of 6.3 days, which often lasted beyond the removal/failure of the PIV cannula. Catheters were useful for primary venous access during hospitalisation and for short TPN courses. Keywords: Brachiocephalic vein, central venous cannulation, paediatric, ultrasonographyAmaç: Ultrason rehberliğinde (USG) brakiyosefalik ven (BCV) kanülasyonunun teknik olarak zor olmadığı gösterilmiştir. Uygulama kolaylığı ve hasta rahatından dolayı, bizim kurumumuzda santral ven kanülasyonu için ilk yaklaşım olarak kabul edilmesinin, santral ven kanülasyonu endikasyonlarını genişletebileceğini varsaymaktayız.Yöntemler: 2012-2014 yılları arasında bağımsız bir çocuk hastanesinde herhangi bir cerrahi operasyon geçiren 16 yaş altındaki hastaların santral yolları retrospektif olarak incelendi. Hastaneden taburcu olana kadar yolların kullanımı ve yönetimi incelendi. Verilerin analizi karşılaştırmalı istatistik yöntemleri ile yapıldı. Bulgular: Kırk dokuz olgu belirlendi. Bunların 20'sinin ağırlığı 10 kg'ın altında iken, 29'unun ağırlığı 10 kg'ın üzerindeydi. Tüm vakalarda kanülasyon başarılıydı. Önemli geç komplikasyonlar görülmedi. Kateterler kazayla yerlerinden çıkmadan ve rahatsız-lık nedeniyle çıkarılmadan ameliyat sonrasında iyi tolere edildiler. Kateterlerin ortalama kalış süresi 6,3 gün (3-20±3,77) olarak bulundu. Dokuzunda acil cerrahide girişi sağlamak için yerleştirildi. On beş olguda bilinen veya karşılaşılan zor periferik intravenöz (PIV) giriş için...

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Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Cannulation of the Brachiocephalic Vein in Infants and Children is Useful and Stable

Thompson¹

2017

Turk J Anaesth Reanim

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“…When placed at the patient side, the left SCV is the more accessible choice, as it allows the operator to hold the US probe in the left hand and the needle in the right hand more freely as stated by Breschan et al (8, 10). Still, when the operator is placed at the patient head, as Kulkani et al reported, the right SCV becomes the more logical choice for the same practical reasons (9). Breschan et al state that the right brachiocephalic vein (BCV) in most cases are shorter the left.…”

Section: Right- Versus Left-sided Catheters As First Choicementioning

confidence: 99%

“…Whereas most reported, the use of applying the coupling gel on the probe and secondarily covering the probe in a sterile sheath, Kulkarni et al (9) used an open-ended sterilized plastic sheath and covered the probe in sterile Tegaderm once it emerged from the plastic sheath, ensuring that no air bubbles were entrapped. They then used a few drops of saline as coupling gel whereas others used sterile US gel (8).…”

Section: Technique—the Bicêtre Experiencementioning

confidence: 99%

Supraclavicular Approach to Ultrasound-Guided Brachiocephalic Vein Cannulation in Children and Neonates

Merchaoui¹,

Lausten-Thomsen²,

Pierre³

et al. 2017

Front. Pediatr.

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The correct choice of intra vascular access in critically ill neonates should be individualized depending on the type and duration of therapy, gestational and chronological age, weight and/or size, diagnosis, clinical status, and venous system patency. Accordingly, there is an ongoing demand for optimization of catheterization. Recently, the use of ultrasound (US)-guided cannulation of the subclavian vein (SCV) has been described in children and neonates. This article gives an overview of the current use of US for achieving central venous catheter placement in the SCV or the brachiocephalic vein (BCV) in neonates. More than 1,250 catheters have been reported inserted in children and neonates for a cumulated success rate of 98.4% and the complication rate is reported to be low. The technical aspects of various approaches are discussed, and we offer our recommendation of an US-guided technique for SCV and BCV cannulation based on our experience in a large NICU setting. Although the cannulation the SCV or BCV does not substitute the use of peripherally inserted central catheters or umbilical venous central catheters in neonates, it is a feasible route in very small children who are in need of a large caliber central venous access.

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“…The subclavian vein (SCV) is the preferred site for CVC insertion because of its lower risk for infection and greater patient comfort in long‐term use 14,15 . An ultrasound‐guided subclavicular approach to SCV (Sup‐SCV) catheterization was first proposed by Yoffa 16 and has been reported as a promising alternative for central venous access, 17 and has been successfully performed in children in recent years 18‐20 . However, the optimal depth of catheterization in children is debated.…”

Section: Introductionmentioning

confidence: 99%

Optimal insertion depth of subclavian vein catheterization via the right supraclavicular approach in children

Tan

Shi

Liu

2021

Pediatric Anesthesia

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Background Methods to determine the optimal insertion depth of ultrasound‐guided supraclavicular approach to the subclavian vein (SCV) catheterization, alternatively used for central venous access, are debatable in children. Aim We investigated the applicability and reliability of the modified formula for determining the depth of SCV catheterization using an ultrasound‐guided supraclavicular approach in children. Methods This prospective observational study included 36 children (age <6 years; weight ≥5 kg) scheduled to undergo congenital heart disease surgery. After intubation, ultrasound‐guided supraclavicular approach to the SCV catheterization was performed. Actual insertion depth was determined by real‐time transesophageal echocardiography. Insertion depth was calculated by subtracting 1 cm from the sum of the distance from the insertion point to the sternal head of the right clavicle and that from the latter point to the midpoint of a perpendicular line drawn from the sternal head of the right clavicle to the line connecting the nipples. Results Insertion depth calculated with the modified formula and actual insertion depth of the SCV catheter correlated strongly (r = .806, 95% confidence interval [CI]: 0.658‒0.908; p < .001). Bland‐Altman analysis showed a mean bias and precision of 0.36 and 0.65 cm, respectively (95% CI: 0.14‒0.58, 95% limits of agreement: −0.92, 1.64). All plots were above the −1.0 line, indicating no catheter tip insertion into the right atrium. Conclusions Optimal insertion depth for an ultrasound‐guided supraclavicular approach to the SCV catheterization can be calculated using modification of a surface landmark formula in children younger than 6 years and weight heavier than 5 kg.

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Ultrasound-guided supraclavicular approach to the subclavian vein in infants and children

Cited by 10 publications

References 2 publications

Ultrasound-Guided Cannulation of the Brachiocephalic Vein in Infants and Children is Useful and Stable

Ultrasound-Guided Cannulation of the Brachiocephalic Vein in Infants and Children is Useful and Stable

Supraclavicular Approach to Ultrasound-Guided Brachiocephalic Vein Cannulation in Children and Neonates

Optimal insertion depth of subclavian vein catheterization via the right supraclavicular approach in children

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