Background: Central venous catheterization is essential for hemodynamic monitoring and rapid fluid administration during pediatric surgeries, with the internal jugular vein (IJV) being a preferred site for access. However, ultrasound-guided IJV cannulation in pediatric patients remains technically challenging. This study aimed to compare the efficacy and safety of the modified dynamic needle tip positioning (MDNTP) technique with the real-time biplane technique in pediatric patients. Methods: This prospective randomized controlled trial enrolled 88 children aged 0-6 years undergoing thoracic or cardiac surgery and requiring IJV cannulation at Chongqing Children's Hospital (November 2023 to April 2024). Eleven anesthesiology residents received standardized simulator-based training in both techniques. The patients were randomized in a 1:1 ratio to either the MDNTP group (using a linear probe) or the real-time biplane group (using a biplane probe). The primary outcomes were the first-attempt success rate and cannulation time. Secondary outcomes included overall success rate, number of puncture attempts, and incidence of complications. The operators, outcome assessors, and statisticians were blinded to group assignments. Statistical analyses were performed using the Mann-Whitney U test and chi-square test. Results: The MDNTP group demonstrated a higher first-attempt success rate (79.5% vs. 54.5%; p = 0.022) and shorter cannulation time (82.50 (55.50-115.50) vs. 108.00 (71.80-174.00) s; p = 0.023) compared to the real-time biplane group, with fewer required puncture attempts (p = 0.015). Both groups achieved similar overall success rates (97.7%) and demonstrated comparable safety profiles, with one minor hematoma in the MDNTP group and none in the biplane group (p = 1.000). Conclusions: Residents performing ultrasound-guided IJV cannulation in pediatric patients using the MDNTP technique had a significantly higher first-attempt success rate and faster cannulation compared to the real-time biplane technique, without compromising safety. Clinical Trial Registration: ChiCTR2300077334.

Background:The incidence of central venous catheter-related thrombosis and the long-term effects of thrombosis on catheterized veins in neonates are unknown. The authors therefore determined the incidence of central venous thrombosis, identified associated risk factors, and evaluated outcomes at 6 months.Methods:The study enrolled neonates aged less than 28 days scheduled for major intestinal or cardiac surgery who were expected to require central venous catheters for at least 48 h. Catheter size, insertion method, and puncture site were determined by the attending anesthesiologist. The duration of catheterization was also determined by clinical need. Central venous thrombi were diagnosed by color Doppler ultrasound imaging within 48 h after catheter removal; results were not shared with clinicians. Ultrasound examinations were repeated 1, 3, and 6 months after discharge.Results:The study enrolled 188 neonates during a period of 2 yr. The median duration of catheter insertion was 12 days. A total of 128 (68%) of the neonates had central venous thrombi at the catheter site, all of which were asymptomatic. Among patients with thrombi, 29 (23%) had complete vessel occlusion and 5 (4%) had venous stenosis at 6 months after discharge. Thrombi therefore spontaneously resolved by 6 months in 73% of the neonates. Central venous catheter to vein diameter ratio, duration of catheterization, and catheter dysfunction were independent risk factors for vessel thrombus. Complete vessel occlusion was most common in patients whose thrombus occupied more than 58% of the vessel at the initial assessment.Conclusions:Covert central venous thrombosis is frequent in neonates who have central venous catheters, and complications are most common in patients who have large intravascular thrombi. Neonates with large intravascular thrombi should be followed and considered for anticoagulation.

Objective This prospective randomized controlled study aimed to compare the ultrasound-guided (USG) technique with the standard single-wall puncture technique for epicutaneo-caval catheter (ECC) placement in neonates. Study Design A total of 100 neonates were included in this study. All enrolled neonates were randomly divided into two groups (n = 50): the USG group and the control group. The control group underwent standard single-wall puncture for ECC placement procedures, and the USG group underwent USG ECC placement procedures. Results The first attempt success rates (62 vs. 38%; p = 0.016) and the total success rates (92 vs. 74%; p = 0.017) were higher in the USG group than in the control group. The procedure time was shorter in the USG group than in the control group: 351.43 (112.95) versus 739.78 seconds (369.13), p < 0.001. The incidence of adverse events was not significantly different between the two groups. Conclusion Compared with the standard single-wall puncture method, USG cannulation is superior for neonatal ECC placement, with a higher success rate, and decreases the total procedural time. Key Points

Background: The aim of this study was to report our initial experience in airway management in young children with severe laryngeal obstruction. Hi-flow nasal cannula oxygen (HFNO) with spontaneous respiration was used as a new airway management strategy in young children undergoing suspension laryngoscopic surgery. Methods: Children aged between 1 day and 24 months scheduled for suspension laryngoscopy were retrospectively studied. The data collected included the patients' age, gender, American Society of Anaesthesiologists physical status classification, comorbidities, preoperative physiological status, methods of induction and maintenance of anesthesia, course of the disease and surgical options, lowest oxygen saturation recorded, transcutaneous CO2, duration of operation, and patients' need for rescue methods. Results: A total of 38 patients successfully underwent suspension laryngoscopy under HFNO with spontaneous respiration. 19 patients were less than 1 year old (7 neonates), while the other half were less than or equal to 2 years old. The median [IQR (range)] lowest oxygen saturation recorded during the operation was 98 [93-99 (91-99)] %. The median [IQR (range)] duration of HFNO with spontaneous respiration was 65 [45-100 (30-200)] minutes. The median [IQR (range)] PCO2/PtcCO2 at the end of the spontaneous ventilation period was 54 [48-63 (39-70)] mmHg, which was the same as the preoperative PCO2 despite a long operation time. Conclusions: HFNO with spontaneous respiration emerged as a new airway management strategy in young children with severe laryngeal obstruction that was beneficial in maintaining oxygenation and was superior to transnasal humidified rapid insufflation ventilatory exchange (THRIVE) in terms of the rising rate of PCO2 in these patients, thereby prolonging the safety time of the operation.

Objective:To explore the value and effect of using microlearning-based flipped classroom teaching mode in teaching ultrasound-guided arteriovenous puncture in undergraduate anesthesia.Methods:Sixty-one newly admitted undergraduate students in the Department of Anesthesiology from September 2021 to October 2022 were selected and divided into traditional teaching group ( n=31) and micro-class flipped classroom group ( n=30) according to the time of admission using the random number table method. The traditional teaching group adopted the traditional teaching mode, while the micro-lesson flipped classroom group adopted the micro-lesson video learning, flipped classroom and after-class consolidation for learning. Both groups were given theoretical tests and skill tests after training. Record the results of theory examination and skill assessment, and evaluate the total results, and questionnaires were distributed to record the self-evaluation of learning outcomes and training satisfaction of all training students. Results:Students in micro-class flipped classroom group scored significantly higher than students in traditional teaching group in the skills assessment and subjective learning experience questionnaire ( P<0.05), while there was no significant difference in theoretical test scores ( P>0.05); students in micro-class flipped classroom group rated their scores mainly in the excellent and good categories, with more students rated as excellent than those in traditional teaching group ( P<0.05). Conclusions:The microlearning-based flipped classroom teaching mode in ultrasound-guided arterial puncture teaching can significantly improve the learning enthusiasm of undergraduate anesthesia students, improve self-learning ability, enhance students' clinical skills of ultrasound-guided arterial puncture, and exercise students' communication and expression ability.

Study objective: To determine whether the long-axis in-plane (LAX-IP) combined with short-axis out-of-plane (SAX-OOP) technique is more suitable than modified dynamic needle tip positioning (MDNTP) technique for ultrasound-guided radial artery catheterization in infants.Design: A randomized controlled trial. Setting: Department of Anesthesiology, Children's Hospital of Chongqing Medical University. Patients: Overall, 72 patients, aged 1-12 months old, who were primarily undergoing thoracic or cardiac surgery in the Children's Hospital of Chongqing Medical University between July 1, 2021, and March 31, 2022, were selected. These patients were randomly divided into two groups: i) the MDNTP group and ii) the LAX-IP com-bined with SAX-OOP group. Interventions: Radial artery cannulation in the two groups was performed using ultrasound-guided MDNTP or LAX-IP combined with SAX-OOP technique.Measurements: The primary outcome was first-time success rate, and the secondary outcomes included total success rate, cannulation time, and incidence of complications. Main results: In the LAX-IP combined with SAX-OOP group, the first-time success rate was 75.0% (n = 27), total success rate was 97.2% (n = 35), cannulation time was 91.39 +/- 102.60 s, puncture attempts was 1.5 +/- 1.3 times, and local hematoma was formed on the first day in one (2.8%) infant. In the MDNTP group, the first-time success rate was 36.1% (n = 13) (P = 0.001; RR, 2.08; 95% confidence interval, 1.29-3.34), total success rate was 91.7% (n = 33) (P = 0.303; RR, 1.06; 95% confidence interval, 0.95-1.19), cannulation time was 181.00 +/- 146.72 s(P = 0.047; Median difference,-89.61; 95% confidence interval,-149.12 to-30.10), puncture attempts was 2.3 +/- 1.6 times (P = 0.133; Median difference,-0.81), and local hematoma was formed on the first day in nine (25%) infants (P = 0.006; RR, 0.11; 95% confidence interval, 0.01-0.83). No thrombosis occurred in any group.

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.

Background: Epicutaneo-caval catheters (ECCs) are extensively used in premature and ill neonates. This prospective, randomized, observational study aimed to compare the outcomes of ECC placement in the distal superficial femoral and axillary veins in neonates with difficult ECC access. Methods: In a neonatal intensive care unit at a tertiary referral center, 60 neonates with difficult ECC access were randomized into two groups with catheters placed using the ultrasound-guided modified dynamic needle tip positioning (MDNTP) technique: distal superficial femoral vein (DSFV) and axillary vein (AV) groups. Results: The first attempt success rate was significantly higher in the DSFV group than in the AV group [23/30 (76.7%) vs 11/30 (36.7%), p = 0.001; odds ratio (OR), 0.176; 95% confidence interval (CI) 0.057–0.543]. The mean procedural duration was significantly shorter in the DSFV group than in the AV group [mean: 308.5 (standard deviation: 81.1) s vs 522.74 (134.8) s, t = −7.17, p < 0.001]. The incidence of complications was significantly lower in the DSFV group than in the AV group [4/30 (13.3%) vs 12/30 (40.0%), p = 0.019; OR, 4.333; 95% CI 1.203–15.604]. The number of attempts was significantly fewer in the DSFV group than in the AV group ( p = 0.012). Conclusions: The distal superficial femoral and axillary veins are two alternative and safe access points for ECC placement in premature neonates (weight < 2.5 kg) with difficult access. However, access through the distal superficial femoral vein was quicker, easier, and had fewer complications than through the axillary vein.

BACKGROUND:Methods to determine the optimal insertion depth of ultrasound-guided supraclavicular approach to the subclavian vein (SCV) catheterization, alternatively used for central venous access, are debatable in children.AIM:We investigated the applicability and reliability of the modified formula for determining the depth of SCV catheterization using an ultrasound-guided supraclavicular approach in children.METHODS:This prospective observational study included 36 children (age <6 years; weight ≥5 kg) scheduled to undergo congenital heart disease surgery. After intubation, ultrasound-guided supraclavicular approach to the SCV catheterization was performed. Actual insertion depth was determined by real-time transesophageal echocardiography. Insertion depth was calculated by subtracting 1 cm from the sum of the distance from the insertion point to the sternal head of the right clavicle and that from the latter point to the midpoint of a perpendicular line drawn from the sternal head of the right clavicle to the line connecting the nipples.RESULTS:Insertion depth calculated with the modified formula and actual insertion depth of the SCV catheter correlated strongly (r = .806, 95% confidence interval [CI]: 0.658-0.908; p < .001). Bland-Altman analysis showed a mean bias and precision of 0.36 and 0.65 cm, respectively (95% CI: 0.14-0.58, 95% limits of agreement: -0.92, 1.64). All plots were above the -1.0 line, indicating no catheter tip insertion into the right atrium.CONCLUSIONS:Optimal insertion depth for an ultrasound-guided supraclavicular approach to the SCV catheterization can be calculated using modification of a surface landmark formula in children younger than 6 years and weight heavier than 5 kg.

BACKGROUND The modified dynamic needle tip positioning (MDNTP) technique for ultrasound-guided radial artery cannulation (MDNTP-US technique) in neonates can be technically challenging for trainee anaesthesiologists. We hypothesised that by associating the MDNTP-US technique with hypodermic 0.9% sodium chloride (Saline MDNTP-US technique), which increases the subcutaneous radial artery depth, the procedure would become easier for trainee anaesthesiologists. OBJECTIVE To compare the Saline MDNTP-US technique, with the MDNTP-US technique for radial artery catheterisation in neonates by trainee anaesthesiologists with limited experience. DESIGN Randomised controlled trial. PATIENTS Ninety-six neonates scheduled to undergo major abdominal surgery requiring continuous arterial pressure monitoring between May 2018 and December 2018 at the Children's Hospital of Chongqing Medical University were enrolled. Neonates with signs of skin erosions or haematomas at or near the insertion site, as well as those with low noninvasive blood pressure values, were excluded. INTERVENTION Neonates were randomised to the Saline MDNTP-US and MDNTP-US groups in a 1 : 1 ratio. Twelve trainees performed the cannulation procedures. MAIN OUTCOME MEASURES Duration of procedure, first attempt success rate, rate of success within 10 min, and the incidence of haematoma and thrombosis. RESULTS The median [IQR] time to perform cannulation was less for the Saline MDNTP-US technique than for the MDNTP-US technique: 203 [160 to 600] vs. 600 s [220 to 600]; P = 0.005. The rate of success within 10 min, 72.9 vs. 47.9%; P = 0.012, was higher in the Saline MDNTP-US group than in the MDNTP-US group. The incidence of haematoma on postoperative day 1 was lower in the Saline MDNTP-US group than in the MDNTP-US group: 8.3 vs. 22.9%; P = 0.049. CONCLUSION Trainee anaesthesiologists can achieve higher success rates by using the Saline MDNTP-US technique instead of the MDNTP-US technique for radial artery catheterisation in neonates, taking less time with a lower incidence of complications. TRIAL REGISTRATION ChiCTR-IOR-17014119 (Chinese Clinical Trial Registry).

目的 探讨超声引导“动态针尖定位”行小儿桡动脉穿刺置管在麻醉规范化培训教学中的效果.方法 选取麻醉专业规范化培训住院医师20人,随机分为超声组(A组)和传统教学组(B组),每组10人.A组采用超声引导桡动脉穿刺置管,B组采用传统的盲穿法.结果 A组第一次穿刺成功率30.0％,B组第一次穿刺成功率12.0％ (P=0.027);A组总成功率44.0％,B组总成功率24.0％ (P=0.035).A组100.0％的规培医生对学习超声引导穿刺有极高的学习兴趣,并认为超声技术是麻醉医生必不可少的技能.结论 超声引导“动态针尖定位”行小儿桡动脉穿刺置管教学有利于提高初学者成功率,增强操作信心,提高学习兴趣.

BackgroundRapid central venous catheterization is critical for the rescue and perioperative management of premature infants requiring surgery. Ultrasound‐guided dynamic needle tip positioning (DNTP) has been widely used as a very effective technique, especially in paediatric vascular puncture and catheterization. However, for low‐weight premature newborns, central vein catheterization still poses greater difficulties for paediatricians and paediatric anaesthesiologists. This prospective randomized control study aimed to evaluate the efficacy of combined short‐ and long‐axis (CSLA) internal jugular vein catheterization for premature newborns in comparison with the DNTP technique.MethodsA total of 90 premature newborns (gestational age < 37 weeks and < 28 days after birth) who were scheduled for surgery were included in this study. All enrolled premature newborns were randomly divided into two groups (n = 45): the CSLA group and the DNTP group. We compared the first‐puncture success rate, total success rate, procedure time, number of needle passes, occurrence of complications and other outcome measures between the two groups.ResultsThe two groups (n = 45 per group) were similar in sex, gestational age, weight, mean arterial blood pressure, and vein‐related measurements of the internal jugular vein. Total success was achieved in 43 (95.6%) and 36 (80.0%) patients in the CSLA and DNTP groups respectively. Compared with the DNTP group, the CSLA group showed a significantly higher first‐attempt success rate (71.1% vs 46.7%, χ2 = 5.5533, P = .0184) and significantly fewer needle passes (1.0[1.0‐2.0] vs 2.0[1.0‐3.0], χ2 = −2.6094, P = .0091). There was no significant difference between the groups in the procedure time (368[304‐573] vs 478[324‐79]s, Z = −1.7690, P = .0769). Complications occurred in both groups, but the incidence was significantly lower in the CSLA group than in the DNTP group (6.7% vs 22.2%, χ2 = 4.4056, P = .0358).ConclusionsUltrasound‐guided internal jugular vein catheterization by the CSLA method is effective and safe. The CSLA method may be superior to the DNTP technique in premature newborns.

近年来,纤维支气管镜被广泛应用于儿童肺部疾病的诊断和治疗.由于其属于侵入性操作,麻醉风险较高.特别是气道高反应患儿,操作中常会发生气道不良事件,如屏气、咳嗽、血氧饱和度下降及检查中断等.本文就气道高反应患儿行纤支镜检查时的特点以及降低其不良反应的方法进行阐述.

Background: Since the outbreak of COVID-19, no official guidelines for urgent surgical management of patients with the COVID-19 concern have been recommended. The current study provides our experience about the management for the patients with suspected or confirmed COVID-19 who required urgent surgical intervention. Methods: From February 5, 2019, to May 26, 2020, there were 5 cases of patients with suspected or confirmed COVID-19 infection managed with urgent surgical intervention in two hospitals in Chongqing. Results: The five cases with COVID-19 concern were admitted with different diseases, including acute intussusception, strangulated inguinal indirect hernia, acute purulent appendicitis, femoral fracture and onset to delivery. Finally, four patients obtained negative results afterwards. One pregnant woman with confirmed COVID-19 infection underwent caesarean section. All medical staff involved in the patients management were well, and no in-hospital transmission occurred Conclusion: Suspected COVID-19 patients must be managed as positive patients until proven or denied in order to minimize the spread and transmission of infection. The current protocol carried out in our practice might be plausible and technically feasible for hospitals when dealing with COVID-19 infection.

目的 探讨沙丁胺醇预先吸入给药对肺炎支原体肺炎患儿纤维支气管镜(简称"纤支镜")灌洗术中气道不良反应的影响.方法 选择该院100例择期行纤支镜灌洗治疗的肺炎支原体肺炎患儿,按照随机数字表法分为对照组和处理组,每组50例.对照组患儿不做处理;处理组患儿于术前5min吸入沙丁胺醇气雾剂2揿(约200μg).所有患儿进入手术室后予右美托咪定、舒芬太尼、丙泊酚快速静脉诱导,而后以丙泊酚持续静脉泵注.术中观察患儿生命体征及不良反应,记录丙泊酚用量、舒芬太尼用量、右美托咪定用量、术中最低血氧饱和度、呛咳发生次数、纤支镜灌洗术暂停次数、手术时间、麻醉复苏时间.结果 两组患儿性别、年龄、体重差异无统计学意义(P>0.05).处理组的丙泊酚使用量中位数为4.00 mg/kg,低于对照组的4.26 mg/kg(P<0.05),差异有统计学意义(P<0.05);呛咳次数大于或等于2次的百分率为36％,低于对照组的96％,差异有统计学意义(P<0.05);灌洗术暂停次数大于或等于2次的百分率为12％,低于对照组的40％,差异有统计学意义(P<0.05).处理组手术时间及复苏时间均明显短于对照组,差异有统计学意义(P<0.05).结论 术前预先吸入沙丁胺醇预可降低肺炎支原体肺炎患儿行纤支镜灌洗术中呛咳发生率,减少低氧血症的发生,术中生命体征更加平稳,术后恢复更快,检查过程更加顺畅、安全.

Background Caudal block is widely used in paediatric anaesthetic practice. Many angles for needle insertion were compared to find a optimal angle during caudal block with high successful caudal injection and minimal risk of complications. The aim of this study is to evaluate the safety and effectivity of a new method of needle insertion at an angel of 90°to the apex of the sacral hiatus for caudal block in newborns. Methods Sixty patients were included in our study, aged 0 to 28 days, posted for inguinal hernia surgery, randomly divided into two groups: a conventional method (CM) group and a new method (NM) group. In both groups, 1 ml∙kg-1 0.5% lignocaine at a rate of approximately 0.5 ml∙s-1 was given for caudal blocks after anaesthesia, and ultrasonographic observation of local anesthetic in the epidural space. Failure rate at the first attempt, puncture frequency, complications, and durations of block were recorded. Results The failure rate at the first attempt of caudal block were 16.7% in the conventional method group and 3.3% in the new method group (p<0.05). The mean time required (standard deviation) to perform needle insertion in the conventional method group was 2.6±0.5 minutes and in new method group 1.6±0.5 minutes (p<0.05). There were three cases aspirating the needle to find blood and one case to find cerebrospinal fluid in the conventional method group. The majority level which the local anesthetic reached are L1 by ultrasound imaging, 86.7% in the conventional method group and 83.3% in the new method group. Conclusion The study found that using the new method, the chance of performing a successful caudal injection can be increased, the time and the risk can be minimized compared to conventional technique. It is a safe and effective method.

BackgroundThe magnitude of pulmonary hypertension (PH) is extremely important with respect to the intra‐operative management of children and infants with an isolated ventricular septal defect (VSD). This study aimed to assess the feasibility and accuracy of transesophageal echocardiography for estimating pulmonary arterial systolic pressure (PASP) across isolated VSD.MethodsWe compared the results of transesophageal echocardiography vs invasive PASP measured simultaneously. This study included 40 patients (age: 6 months to 6 years; weight: >5 kg) who were undergoing elective surgery for isolated VSDs. Flow signals across the VSDs were identified as high velocity turbulent signals in systole via continuous wave Doppler at 0–120° at the mid‐esophageal level. Peak velocities were recorded. Radial artery systolic pressures were assessed invasively, and PASPs were obtained after exposing the pulmonary artery intra‐operatively.ResultsAfter excluding five patients because of unusable measurements, invasive PASP measurements were obtained in 35 patients (87.5%). There were no significant biases between echocardiographic and catheterization measurements of PASP, with a tight confidence interval measuring, on average, up to 2.6 mmHg. However, the ± 2 standard deviation limits of agreement for mean PASP were −3.8 and 10.6 mmHg.ConclusionPASP measurements via transesophageal echocardiography in cardiac surgical patients under general anesthesia are recommended for use as a screening and monitoring tool for PH in children and infants, but cannot be used as a diagnostic tool.

目的 评价"动态针尖定位"超声引导技术在新生儿颈内静脉穿刺临床教学中的效果.方法 选取麻醉专业学位研究生共24人,随机分为超声组和盲穿组,每组12人.超声组采用"动态针尖定位"超声引导技术新生儿颈内静脉穿刺,盲穿组采用解剖盲探法.结果 超声组第一次穿刺成功12例,第一次穿刺成功率25.0％;总穿刺成功41例,总成功率85.4％.盲穿组第一次穿刺成功9例,第一次穿刺成功率18.8％;总穿刺成功25例,总成功率52.1％,与超声组相比差异有统计学意义.并发症情况:超声组误穿动脉0例;血肿2例,血肿发生率4.2％.盲穿组误穿动脉8例,误穿动脉发生率16.7％;血肿10例,血肿发生率20.8％,与超声组相比差异有统计学意义.两组均没有气胸发生.结论"动态针尖定位"超声引导技术新生儿颈内静脉穿刺临床教学中具有优势,值得推广.

BACKGROUND: Radial artery cannulation is extremely challenging in neonatal patients. Herein, we compared the success rate of the modified dynamic needle tip positioning short-axis, out-of-plane, ultrasound-guided technique with that of the traditional palpation technique in neonatal radial artery cannulation. METHODS: Sixty term neonates undergoing major abdominal surgery were randomized into the ultrasound or palpation group via the sealed-envelope method. The ultrasound group underwent radial artery cannulation using an ultrasonic apparatus, while traditional palpation of arterial pulsation was used in the palpation group. The arterial diameter and depth were measured on ultrasound before the puncture. We recorded age, weight, sex, and other background characteristics. The primary outcomes included the first-attempt, total success rates, and the total puncture procedure duration. Secondary outcomes included the incidence of complications (hematoma and thrombosis). Data were compared between the 2 groups. RESULTS: Sixty term neonates were enrolled in the study. The success rates of the first attempt in the ultrasound and palpation groups were 40% (n = 30) and 10% (n = 30), respectively ( P = .007; relative risk, 4.0; 95% confidence interval, 1.3–12.8). The total success rate was 96.7% in the ultrasound group and 60.0% in the palpation group ( P = .001; relative risk, 1.61; 95% confidence interval, 1.19–2.17). The average time to accomplish radial artery cannulation in the ultrasound and palpation groups was 91.4 ± 55.4 and 284.7 ± 153.6 seconds, respectively ( P < .001; estimated difference, −193; 95% confidence interval, −256 to −130). In addition, 3.3% of the patients in the ultrasound group and 26.7% in the palpation group suffered puncture hematoma ( P = .026; relative risk, 0.13; 95% confidence interval, 0.02–0.94). CONCLUSIONS: Modified dynamic needle tip positioning short-axis, out-of-plane, ultrasound-guided radial artery cannulation in neonates improves the first-attempt and total success rates and decreases the total procedural time and incidence of cannulation-related complications.