Ultraschallgesteuerte zentralvenöse Punktion bei neuropädiatrischen Patienten unter Vermeidung von potentiell hirndrucksteigernden Maßnahmen

Background. Certain measures such as the Trendelenburg position or an increase in intrathoracic pressure raise the chances for a successful puncture of the internal jugular vein (IJV) particularly in paediatric patients. However, these measures are contraindicated in patients with increased intracranial pressure. Therefore, in anaesthetised and ventilated neuropaediatric patients we investigated whether ultrasound-guided cannulation of the IJV can replace these measures. Methods. In this prospective study,8 new-borns,46 infants and 66 small children were included. The cross-sectional area of the right IJV was sonographically measured in horizontal and 15° Trendelenburg positions with or without PEEP 0, 5 or 10 cm H 2 O. The IJV was then punctured at the conditions of a predetermined position and PEEP combination under sonographic guidance (5-8 MHz). Results. The mean cross-sectional area of the IJV was 0.3-1.6 cm 2 in the horizontal position without PEEP (n=120) and was enlarged due to the Trendelenburg position by 24% and by 63%,when PEEP 10 cm H 2 O was added. Independent of positioning and PEEP the ultrasound-guided puncture was successful at the first attempt in 98% of cases and a second attempt had to be made in only two children. Conclusions. Under sonographic visualisation of the cross-sectional area, the IJV can easily and safely be punctured for central venous cannulation in newborn, infants and small children without measures such as the Trendelenburg position or implementation of PEEP.