Complications of 1309 internal jugular vein cannulations with the anatomic landmarks technique in infants and children.

PURPOSE

Report the procedural complications of internal jugular vein (IJV) catheter insertion in infants and children and discuss how to prevent them.

METHODS

An observational study was performed from January 2006 to August 2010; 1309 internal jugular vein cannulae were inserted in the operating room by either staff or resident anesthesiologists. Patient age, weight, sex, type of catheter (diameter, lumen number), number of attempts, and complications were recorded. The discussion is focused on how to prevent or reduce internal jugular vein line insertion related complications in infants and children.

RESULTS

1309 IJV cannulae were inserted, 85.63% of catheters placed were successful after one to three attempts. Complications included 12 arrhythmias (0.91%), 25 arterial punctures (1.90%), 16 hematomas (1.22%), 17 device occlusions, breaks or malpositions (1.29%), 11 line-related infections (0.84%), four cases of thrombus (0.31%), two cardiopulmonary arrests (0.15%), two hemothoraces (0.15%), five pneumothoraces (0.38%), and one guidewire winding (0.07%). The complication rates of resident anesthesiologists were significantly higher compared to staff anesthesiologists for both common and rare complications (4.27% versus 2.21%; 0.68% versus 0.07%, respectively). In addition, residents' number of attempts were greater than staff anesthesiologists (1.84 and 1.38, respectively).

CONCLUSIONS

The IJV catheterization was feasible in infants and children. To reduce the risk of complications, the procedure should be performed or supervised by staff anesthesiologists; inserting the needle, guidewire, dilator, and the catheter too far should be avoided. It is now commonly accepted that all central venous cannulations should be performed under ultrasound guidance, especially in children.