Comparison Between Central Venous Catheter Placement and Ultrasound Guide and Anatomical Landmarks in Pediatric Patients Undergoing Cardiac Surgeries

Controversies exist surrounding the advantages and disadvantages of anatomical landmarks (ALs) and ultrasound (US) guidance as 2 methods of central venous catheter (CVC) placement among pediatric patients. The present study compared the success rate and complications of CVC placement in the internal jugular vein between US guidance and traditional AL methods among pediatric patients.

The present open-labeled randomized clinical trial was performed on 120 pediatric patients aged 3 months to 6 years undergoing cardiac surgeries. The patients were randomly allocated to the US-guided and AL groups. After the induction of anesthesia and intubation, the CVC was placed according to the placement method of each trial group. The success rate of first-attempt CVC placements was the primary outcome, while placement time, vein punctures, and arrhythmias constituted the secondary outcomes.

The trial assessed 120 patients (63, 52.5% female). The mean CVC placement time was 204.1±111.7 seconds. The success rate of first-attempt CVC placements was the same in both groups (47/60; 78.33%). The AL group experienced significantly more side effects than the US-guided group (23 arrhythmias [38.33%]   and 5 arterial punctures [8.33%] vs 2 arrhythmias [3.33%] and 3 arterial punctures [5%]; P<0.001).

The complication rate of CVC placement in the US-guided group was lower than that in the AL group; thus, the former method can be considered safer in pediatric patients.