Ultrasound guided internal jugular vein cannulation in pediatric patients: a randomized controlled trial

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.