Ultrasound detection of guidewires in-plane during pediatric central venous catheterization.

Objective/Aim To assess the usefulness of longitudinal ultrasound images of guidewires for pediatric central venous catheter (CVC) placement. Background To avoid arterial placement of a CVC, it is important to ensure that the guidewires are in the internal jugular vein (IJV) before inserting the dilators. Ultrasound confirmation of the guidewire position may eliminate accidental arterial dilation during CVC cannulation. Methods Fifty pediatric patients undergoing general endotracheal anesthesia for cardiovascular surgery were enrolled. The mean +/- sd value for age was 14.8 +/- 16.8months; height, 69.1 +/- 14.6cm; and weight, 7.1 +/- 3.2kg. Longitudinal ultrasound images of guidewires in or around the right IJV during pediatric CVC placement were acquired using an L10-5 MHz probe (TiTAN (R); SonoSite Co., Tokyo, Japan), with the neck of the patient fully extended and the head turned 1530 degree to the left. Results In 42 (84%) patients, guidewires were visible in the lumen of the IJV. However, in 8 (16%) patients, guidewires were not visible. Longitudinal imaging of guidewires was achieved with high probability (100%) in children in whom the distance from the clavicle to the angle of the mandible was more than 59mm, in whom the distance from the clavicle to the puncture site was more than 30mm, or in children taller than 65cm. All cannulations were confirmed to be CVCs by chest radiography. Conclusions To confirm the insertion of dilators into veins in children, we recommend that longitudinal images of the guidewires should be initially acquired.