الفهرس 
Anatomical ConsiderationsOnly 14 pages are availabe for public view
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Abstract
The insertion of CVCs is a common practice that is associated with significant morbidities which are both hazardous to patients and expensive to treat.
Catheterization of the internal jugular vein (IJV) is commonly attempted to obtain central venous access for hemodynamic monitoring, long-term administration of fluids, antibiotics, total parenteral nutrition, and hemodialysis in critical care patients.
The success rate of central venous cannulation is lower and the complication rate is higher in infants and children than in adults.
Traditionally, internal jugular vein cannulation has been performed with the use of external anatomical landmarks and palpation to guide insertion of the needle into the vessel. However, depending on the operator’s experience and the patient’s anatomy, this procedure may be difficult or unsuccessful. This method requires good knowledge with the anatomy which has many variations. The anatomy of the IJV is sufficiently different among individual patients to complicate vascular access with the conventional method.
The use of ultrasound imaging before or during vascular cannulation is thought to improve first-pass success and reduces complications. Practice recommendations for the use of ultrasound for vascular cannulation have emerged from numerous specialties, governmental agencies such as the National Institute for Health and Clinical Excellence and the Agency for Healthcare Research and Quality’s evidence report.
Using US imaging for CVC insertion requires knowledge with basics of US waves which are simply sound waves with a frequency above the limits of human hearing. In most diagnostic applications, frequencies in the 2–20MHz., their attenuation which is the loss of energy from the ultrasound beam as it passes through tissue, US transducers which serves as a generator of US wave and a receiver of reflected echoes and their types. It also mandates training on the US machine to improve hand-eye coordination and to see the different views (LAX & SAX) and different modes (especially B-mode & Doppler).
In our study, US-guided IJV cannulation in pediatric age group proved that it is superior to landmark guided method in reducing the number of skin punctures, incidence of arterial puncture, overall complications number and rate. While, it proved to be consuming significantly longer time. Regarding other major complications and the cost, the difference was not significant.
These results may need further studies on lager pediatric population for more representative data. We also recommend training of the anesthetists specially the junior staff on using ultrasound technique in IJV cannulation in pediatrics without the omission of the conventional technique.