Central Venous Catheterization

Central venous catheterization (CVC) via the internal jugular vein (IJV) is a fundamental procedure in anesthesia and intensive care for hemodynamic monitoring, fluid resuscitation, and vasoactive drug administration. While modern clinical guidelines strongly advocate for ultrasound (USG) guidance, the traditional anatomical landmark technique remains widely utilized due to equipment availability or clinician habits. Proper positioning of the catheter tip is critical to prevent severe long-term complications; however, comparative data regarding catheter tip malposition between these two routine techniques-especially when confirmed by postprocedural bedside chest X-ray-require further prospective evaluation. Objective: The primary objective of this prospective observational study is to compare ultrasound-guided versus landmark techniques for internal jugular vein catheterization with respect to catheter tip malposition, as determined by postprocedural bedside chest X-ray. Secondary objectives include the evaluation of the number of needle redirections, first-attempt success rate, total procedure time, and the incidence of mechanical complications (such as accidental arterial puncture or hematoma formation)

Using medications to increase blood pressure, called vasopressors, is invaluable in treating patients who have difficulty maintaining stable blood pressure. Vasopressors are usually infused through a central venous catheter (CVC), which is a flexible tube placed in the large vein of the neck, arm or groin. CVCs require a skilled clinician and often with an ultrasound to prevent complications such as a collapsed lung or bleeding. Alternatively, the infusion of vasopressors through a peripheral venous catheter (PVC), a thin tube placed in the smaller veins of the arm or hand has been avoided due to the risk of extravasation, which is the leakage of fluid to surrounding tissues. This can lead to potential tissue death requiring surgery. However, emerging research shows the safety of infusing vasopressors through a PVC, referred to as peripheral vasopressors. There is a growing interest in peripheral vasopressors for two main reasons: to expedite vasopressor initiation in patients with refractory shock and to avoid CVC placement and its potential complications. However, a standardized protocol for administration is lacking and many clinicians still avoid peripheral vasopressors due to lack of high-quality evidence. The investigators will examine the effectiveness of implementing a peripheral vasopressor protocol by conducting a feasibility study and assessing outcomes such as the safety of peripheral vasopressors and the acceptability rate of healthcare providers. By conducting this study, the investigators aim to provide the framework to conduct larger, multi-center trials and to provide high-quality data for the future use of a standardized peripheral vasopressor protocol.

The aim of this study was to compare the three approaches: open technique, modified Seldinger's technique and closed ultrasound-guided Central venous catheterization insertion for central line insertion in infancy as regards safety, success of cannulation, technique time, and preservation of the patency of the internal jugular vein.