Combined short- and long-axis method for internal jugular vein catheterization in premature newborns: A randomized controlled trial.

Abstract

Rapid central venous catheterization is critical for the rescue and perioperative management of premature infants requiring surgery. Ultrasound-guided dynamic needle tip positioning (DNTP) has been widely used as a very effective technique, especially in paediatric vascular puncture and catheterization. However, for low-weight premature newborns, central vein catheterization still poses greater difficulties for paediatricians and paediatric anaesthesiologists. This prospective randomized control study aimed to evaluate the efficacy of combined short- and long-axis (CSLA) internal jugular vein catheterization for premature newborns in comparison with the DNTP technique. A total of 90 premature newborns (gestational age < 37 weeks and < 28 days after birth) who were scheduled for surgery were included in this study. All enrolled premature newborns were randomly divided into two groups (n = 45): the CSLA group and the DNTP group. We compared the first-puncture success rate, total success rate, procedure time, number of needle passes, occurrence of complications and other outcome measures between the two groups. The two groups (n = 45 per group) were similar in sex, gestational age, weight, mean arterial blood pressure, and vein-related measurements of the internal jugular vein. Total success was achieved in 43 (95.6%) and 36 (80.0%) patients in the CSLA and DNTP groups respectively. Compared with the DNTP group, the CSLA group showed a significantly higher first-attempt success rate (71.1% vs 46.7%, χ²  = 5.5533, P = .0184) and significantly fewer needle passes (1.0[1.0-2.0] vs 2.0[1.0-3.0], χ²  = -2.6094, P = .0091). There was no significant difference between the groups in the procedure time (368[304-573] vs 478[324-79]s, Z = -1.7690, P = .0769). Complications occurred in both groups, but the incidence was significantly lower in the CSLA group than in the DNTP group (6.7% vs 22.2%, χ²  = 4.4056, P = .0358). Ultrasound-guided internal jugular vein catheterization by the CSLA method is effective and safe. The CSLA method may be superior to the DNTP technique in premature newborns.