Ultrasound guidance for internal jugular vein cannulation in neonates: Modified dynamic needle tip positioning short-axis out-of-plane technique versus long-axis in-plane technique, a randomized controlled trial

Background: Ultrasound-guided central venous catheter placement has significantly improved the success rate of punctures and reduced the risk of complications. However, catheterizing the internal jugular vein under ultrasound guidance in neonates remains challenging.Methods: Ninety-six patients were screened for eligibility in this randomized controlled trial between November 2018 and October 2019. After meeting the inclusion criteria, 90 term neonates undergoing cardiothoracic, general, or neurosurgery procedures were randomly assigned to the modified dynamic needle tip positioning short-axis (n= 45) or long-axis groups (n= 45) using a computer-generated random numbers table. The primary outcome was the first-attempt success rate. The secondary outcomes included the total success rate, cannulation time, and incidence of cannulation-related complications, including hematoma, accidental arterial puncture, or pneumothorax. Data were compared between the two groups.Results: The success rate for the first attempt was higher (88.9% vs 64.4%; p= 0.001; relative risk, 1.4; 95% confidence interval, 1.1–1.8), while the cannulation time was shorter (171.0 ± 47.8 s vs 304.4 ± 113.5 s; p= 0.001; estimated difference, −133.4; 95% confidence interval, −170.1 to −96.7), in the modified dynamic needle tip positioning short-axis group compared with the long-axis group. Six hematomas and two common carotid artery punctures were identified in the long-axis group, while none were identified in the modified dynamic needle tip positioning short-axis group.Conclusions: The modified dynamic needle tip positioning short-axis out-of-plane technique enhanced the procedural efficacy and safety of internal jugular vein catheterization in neonates.