Ultrasound-guided innominate vein cannulation in children
Abstract:
Background: Central venous access remains critical in pediatric care. While the landmark-guided subclavian vein (LT-SCV) approach has been historically common, ultrasound-guided innominate vein (US-IV) cannulation has emerged as a safer alternative.
Methods: We conducted a retrospective analysis of 3,521 central venous access procedures performed between July 2014 and April 2023 at a tertiary pediatric referral center. Two groups were compared: LT-SCV (n = 2,490) and US-IV (n = 1,031). We assessed success rates, complication rates, and procedure-related variables including number of needle passes, arterial puncture, thoracic complications, and central line-associated bloodstream infections (CLABSI).
Results: The US-IV group demonstrated a significantly higher technical success rate (94.6% vs. 76.9%, p < 0.001) and fewer needle passes (median 1 vs. 2, p < 0.01). Arterial puncture (2.7% vs. 4.5%, p = 0.014) and conversion to contralateral vein access (3.3% vs. 21.7%, p < 0.001) were significantly lower in the US-IV group. Major mechanical complications were more frequent in the LT-SCV group (1.04% vs. 0.3%, p = 0.016), including 10 hemothoraces and 16 pneumothoraces. All thoracic duct injuries occurred in the US-IV group (n = 3), likely due to anatomical proximity. CLABSI rates were similar between groups (1.07 vs. 1.11 per 1,000 catheter-days, p = 0.76).
Conclusion: Ultrasound-guided innominate vein cannulation is safer and more effective than landmark-guided subclavian access in children, with higher success rates and fewer complications. While landmark techniques retain value in training and resource-limited settings, structured implementation of ultrasound-guided protocols should be prioritized to improve pediatric vascular access outcomes.
Level of evidence: Level IV (Case series with no comparison groups).
Reference:
Pablo Damián A, Ignacio SJ, Emiro RP, Paula F, Mariano B, Marcelo B, Vícto A. COMPARISON OF LANDMARK-GUIDED SUBCLAVIAN VERSUS ULTRASOUND-GUIDED INNOMINATE VEIN CANNULATION IN CHILDREN: A RETROSPECTIVE ANALYSIS OF COMPLICATIONS AND OUTCOMES. J Pediatr Surg. 2025 Oct 23:162743. doi: 10.1016/j.jpedsurg.2025.162743. Epub ahead of print. PMID: 41138769.