ORIGINAL ARTICLE   

Minerva Pediatrics 2022 April;74(2):181-7

DOI: 10.23736/S2724-5276.21.06180-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

The bedside practice of sonographic guided internal jugular vein access in critically ill premature infants

Ahmet B. DOĞAN ¹ ✉, Ahmet G. GÜLER ², Sadık YURTTUTAN ³, Gözen ÖKSÜZ ⁴

¹ Department of Pediatric Surgery, School of Medicine, Erciyes University, Kayseri, Turkey; ² Department of Pediatric Surgery, School of Medicine, Sütçü İmam University, Kahramanmaraş, Turkey; ³ Department of Neonatology, School of Medicine, Sütçü İmam University, Kahramanmaraş, Turkey; ⁴ Department of Anesthesiology and Reanimation, School of Medicine, Sütçü İmam University, Kahramanmaraş, Turkey

BACKGROUND: Intrahospital transport, general anesthesia, and the prolonged duration of the central venous catheterization (CVC) in unfavorable conditions pose a significant risk to a critically-ill premature infant. We aimed to demonstrate a minimalized and safe manner of CVC in this patient population.
METHODS: We worked on a prospective study in 51 critically-ill premature infants in which a 22 Gauge catheter was put in one of the central thoracic veins with the guidance of sonography as a bedside procedure. Of the patients, 27 (53%) were extremely premature, and 21 (41%) were extremely low birth weight infants (ELBW). The mean gestational age was 29±5 weeks, and the mean weight at the time of the procedure was 1655±1028 grams. While no anesthetic and sedative drugs were administered to ELBW infants during procedures, in the remainder of the cohort, procedures were carried out only under sedoanalgesia.
RESULTS: Vascular access was achieved in 48 (94%) of the patients after a mean number of 1.47±0.75 attempts. Body heat loss of the patients at the end of the procedures was not statistically significant (P=0.164). However, ELBW infants lost their body heat significantly more than the rest of the cohort (P=0.032). We experienced clinically insignificant common carotid artery puncture in three patients and hemothorax in one patient.
CONCLUSIONS: CVC of critically ill premature infants can be safely and successfully achieved in incubators using sonography guidance, protecting them from hypothermia and anesthetic drugs.

KEY WORDS: Jugular veins; Catheterization; Infant, low birth weight; Hypothermia