Ultrasound guided internal jugular vein access in children and infant: A meta‐analysis of published studies |
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| Authors: | STEPHANIE SIGAUT MD ALIA SKHIRI MD IDA STANY MD JONATHAN GOLMAR MD YVES NIVOCHE MD PhD ISABELLE CONSTANT MD PhD ISABELLE MURAT MD PhD SOUHAYL DAHMANI MD PhD |
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| Affiliation: | 1. Assistant Professor of Anesthesia, Robert Debre University Hospital;2. Professor of Anesthesia, Head of Department, Robert Debre University Hospital;3. Professor of Anesthesia, Trousseau University Hospital;4. Professor of Anesthesia, Head of Department, Trousseau University Hospital, Paris, France |
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| Abstract: | Introduction: Central venous catheter placement is technically difficult in pediatric population especially in the younger patients. Ultrasound prelocation and/or guidance (UPG) of internal jugular vein (IJV) access has been shown to decrease failure rate and complications related to this invasive procedure. The goal of the present study was to perform a systematic review of the advantages of UPG over anatomical landmarks (AL) during IJV access in children and infants. Material and methods: A comprehensive literature search was conducted to identify clinical trials that focused on the comparison of UPG to AL techniques during IJV access in children and infants. Two reviewers independently assessed each study to meet inclusion criteria and extracted data. Data from each trial were combined to calculate the pooled odds ratio (OR) or the mean differences (MD), and their 95% confidence intervals [CI 95%]. I² statistics were used to assess statistics heterogeneity and to guide the use of fixed or random effect for computation of overall effects. Subgroup analysis was used to clarify the effects of the techniques used (prelocation or guidance) or the experience of practitioners. Results: Literature found five articles. Most of the patients were cardiac surgery patients. In comparison with AL, UPG had no effect on IJV access failure rate (OR = 0.28 [0.05, 1.47], I² = 75%, P = 0.003), the rate of carotid artery puncture (OR = 0.32 [0.06, 1.62], I² = 68%, P = 0.01), haematoma, haemothorax, or pneumothorax occurrence (OR = 0.40 [0.14, 1.13], I² = 17%, P = 0.30, OR = 0.72, OR = 0.81 [0.18, 3.73], I² = 0%, P = 0.94, respectively) and time to IJV access and haemothorax/pneumothorax occurrence. Subgroup analysis found an efficacy of ultrasound when used by novice operators or during intraoperative use. Discussion: This current meta‐analysis does not found the utility of ultrasound during IJV access in children and infants in increasing the success rate and in decreasing complications. |
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| Keywords: | Haematoma internal jugular vein internal carotid artery pneumothorax ultrasound |
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