An Innovative Method to Prevent Guidewire Access to the Ipsilateral Internal Jugular Vein During Pediatric Subclavian Vein Cannulation.

OBJECTIVES

To investigate whether an innovative method of occluding the internal jugular vein (IJV) by applying temporary pressure at the IJV just above the clavicle could help prevent catheter misplacement into the IJV, which often occurs during pediatric subclavian vein (SCV) catheter placement.

DESIGN

This was a randomized controlled trial.

SETTINGS: This study was conducted in a single medical center.

PARTICIPANTS

One hundred and seventy-eight children undergoing SCV catheterization were recruited.

INTERVENTIONS: Children were assigned at random to the traditional © group (unassisted placement of the guidewire) or the innovative (I) group (temporary pressure on the IJV just above the clavicle to occlude the IJV during guidewire placement).

MEASUREMENTS AND MAIN

RESULTS

The primary outcome was the incidence of guidewire misplacement into the IJV at the time of first placement. Secondary outcomes included the total number of attempts and the total time of guidewire placement. The incidence of misplacement at the first attempt was reduced from 18.06% in group C to 6.67% in group I (p = 0.04). The total number of guidewires entering the IJV was lower in group I compared to group C (24/96 in group C v 7/82 in group I; p = 0.005). The total median time of guidewire placement was reduced from 35.00 seconds (18.25-54.00 seconds) in group C to 26.00 seconds (17.00-38.00 seconds) in group I (p = 0.03).

CONCLUSIONS

Temporary pressure at the IJV just above the clavicle to occlude the IJV during placement of the guidewire helps prevent inadvertent placement of the guidewire into the IJV.