TEACHING SUCCESSFUL CENTRAL VENOUS CANNULATION IN INFANTS AND CHILDREN - AUDIO DOPPLER VERSUS ANATOMIC LANDMARKS

Objective: To determine if vein localization with an audio Doppler inc reases successful central Venous cannulation and decreases complicatio ns in infants and children when performed by inexperienced operators, compared with vein localization by anatomic landmarks (ALs). Design:A prospective cohort of infants and children undergoing central venous c annulation for cardiac surgery. Setting: A university-affiliate childr en's hospital with a pediatric anesthesia fellowship program. Particip ants: All infants and children undergoing cardiac surgery between July 1, 1996, and January 1, 1997. Interventions:Subjects had central veno us catheters (CVCs) placed by an anesthesia fellow by either ALs or au dio-Doppler localization of the veins. Measurements and Main Results: Eighty-four children were studied. Internal jugular Vein (IJV) cannula tion was attempted in 71 (85%) children and femoral vein cannulation 1 3 (15%) children. Time to catheter insertion, number of needle passes, and artery puncture were noted. Sixty-one of 63 (97%) children had su ccessful central venous cannulation by an anesthesia fellow using audi o-Doppler vein localization. This was significantly greater than the 1 3 of 21 (62%) successful cannulations among children who had veins loc alized by ALs. Time to insertion did not differ by method of Vein loca lization; however, the number of needle passes was significantly great er in the AL group. Artery puncture did not differ significantly by me thod of vein localization. Conclusion:Vein localization by audio Doppl er significantly increases the rate of successful central venous cannu lation and decreases the number of needle passes in pediatric patients when used by inexperienced operators. Copyright (C) 1998 by W.B. Saun ders Company.