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Usefulness of ultrasound-guidance to infraclavian cannulation in paediatrics
- Sebastien Grousson, Frederic Duflo, Florence Tahon (28 August 2007)
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Sebastien Grousson Neurosurgical Hospital Lyon France, Frederic Duflo, Florence Tahon
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We have read with great interest the article by Pirotte and Veyckemans(1) relating the ultrasound (US)-guided for infraclavicular venous cannulation in children. We would like to congratulate the authors for having described for the first time the principle of the US-guidance technology for the subclavian vein access. Although the landmark catheter insertion method remains efficient, US-guidance technique validated for the internal jugular vein access(2,3) is gaining popularity - indeed, the time required for insertion is reduced, the number of attempts and the failure rate are lower. Unfortunately, until this recent published article, the expected objectives of the US locating devices to minimize both the risks of pneumothorax and arterial puncture are not available for the subclavian venous catheterization. The method reported by Pirotte and Veyckemans highlights not only the supraclavicular but also the medial position of the US probe. Alternatively, we suggest a more lateral approach for both infra and supraclavicular probe positioning to optimize the thorax apex view. In this setting, the main advantage is to individualize on the same screen the bone markers, the subclavian vessels and the pleural dome. With this specific US beam orientation, the different anatomical structures are aligned to better avoid pneumothorax, because the pleural dome is protected by the first rib (View Image View Image View Image). These regional subclavian relationships were well described twenty years ago,(4)and our method of US-guidance (lateral approach) clearly secures subclavian venous catheterization against pneumothorax. Even if this technique, commonly used in our institution, requires controlled and randomized trials, US- guidance permits a new approach for subclavian vein cannulation. References: (1) Pirotte T and Veyckemans F. Ultrasound guided subclavian vein cannulation in infants and children: a novel approach. Br J Anaesth 2007; 98: 509-14 (2) Alderson PJ, Burrows FA, Stemp LI, Holtby HM. Use of ultrasound to evaluate internal jugular vein anatomy and to facilitate central venous cannulation in paediatric patients. Br J Anaesth 1993; 70: 145-8 (3) Verghese ST, McGill WA, Patel RI, Sell JE, Midgley FM, Ruttimann UE. Ultrasound-guided internal jugular venous cannulation in infants. Anesthesiology 1999; 91: 71-7 (4) Cobb LM, Vinocur CD, Wagner CW, Weintraub WH. The central venous anatomy in infants. Surg Gynecol Obstet 1987; 165: 231-4 Conflict of Interest:None declared |
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