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BJA Advance Access published online on March 1, 2007
British Journal of Anaesthesia, doi:10.1093/bja/aem041
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Ultrasound-guided subclavian vein cannulation in infants and children: a novel approach

T. Pirotte* and F. Veyckemans

Department of Anaesthesia, Université Catholique de Louvain, Cliniques universitaires St-Luc, Brussels, Belgium

* Corresponding author: Department of Anaesthesia, Université Catholique de Louvain, Cliniques universitaires St-Luc, Avenue Hippocrate 10-1821, 1200 Brussels, Belgium. E-mail: thierry.pirotte{at}clin.ucl.ac.be

Background: Central venous cannulation in infants remains challenging even for experienced paediatric anaesthesiologists. Ultrasound (US)-guidance techniques are proven to be safer for internal jugular vein catheterization. But the subclavian vein (SCV) is often the preferred site for long-term central venous catheterization in children. We describe a novel US-guided approach for SCV cannulation in infants and children.

Methods: The principle of this technique is to place the US probe at the supraclavicular level to obtain a longitudinal view of the SCV, and to gain access to the vein via the usual infraclavicular route to cannulate it under ultrasonic control. Details and pitfalls of this technique are described. The prospectively collected results of our first 25 punctures are reported.

Results: Patients' weight and age range were 2.2–27 kg and 1 day to 9 yr, respectively: 76% of the children weighed less than 10 kg. The success rate at the first attempt was 84% and 100% after two attempts. An asymptomatic thrombus in the SCV could also be detected with this technique.

Conclusions: This US-guided approach of the SCV offers a new possibility for central venous catheterization in children. This technique seems promising for children less than 10 kg and probably also for older children. It provides good quality needle guidance and allows to check the vessel patency before puncture.

Keywords: children; monitoring, ultrasound; vein, subclavian


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