Application Of Single-operator Laser-assisted Ultrasound Guided Central Venous Catheterization In Pediatric Patients

Objective:Central venous catheterization in Pediatric patients is challenging in clinical anesthesia.In this study,we invented a single-operator laser-assisted ultrasound guided system to explore whether the effectiveness and safety of this new ultrasound guided method in pediatric patients with central venous catheterization is superior to the traditional ultrasound guided method.Methods:A total of 58 pediatric patients aged from 6 months to 6 years who were planning to undergo general anesthesia and had indications for central venous catheterization were enrolled.They were randomly divided into control group(TUG group)and experimental group(LAUG group),with 29 patients in each group.After general anesthesia induction,ultrasound guided central venous catheterization was performed by anesthesiologists with rich experience in ultrasound use.The primary outcome was the success rate of the first guided-wire insertion.The secondary outcomes included the first success rate of catheterization,the overall success rate of catheterization,the first needle tip position and the median rate of the first needle tip position,the number of needle tip direction adjustments,the number of puncture attempts,the positioning time,the time of successful catheterization and the incidence of complications.Results:The success rate of the first guided-wire insertion in LAUG group [29/29,(100.00%)] was significantly higher than that in TUG group [22/29,(75.86%)],there was a statistical difference between the two groups(P=0.010).The number of needle direction adjustments in LAUG group were significantly less than that in TUG group[(1.12±0.93)times VS(3.24±1.46)times],there was a statistical difference between the two groups(P<0.001).The successful catheterization time in LAUG group was also significantly shorter than that in TUG group [ 226.62(215.50-244.37)s VS249.31(232.18-395.36)s],there was a statistical difference between the two groups(P<0.001);the positioning time of the LAUG group was significantly longer than that in TUG group [19.57(18.65-20.50)s vs 9.38(8.96-10.17)s],and the two groups also had a statistical difference(P<0.001).Compared with TUG group,the first needle tip position of LAUG group had statistical differences(P<0.001)in "poor" position(13.79% VS 55.17%)and "ideal" position(79.31% VS 27.59%),had statistical differences(P=0.023;P=0.028)in "good" position(44.83% VS 17.24%)and "best" position(34.48% VS 10.35%),and had no statistical difference(P>0.05)in "general" position(6.90% VS 17.24%).Compared with TUG group,there was no statistical difference in the first success rate of catherization,the overall success rate of catherization,the number of puncture attempts and the incidence of complications in LAUG group(P>0.05).In addition,there was no statistical difference in the general baseline characteristics between the two groups(P>0.05).There was no statistical difference in the depth,anteroposterior diameter and transverse diameter of the internal jugular vein between the two groups(P>0.05).There was no statistical difference in the relative position between the internal jugular vein and the carotid artery between the two groups(P>0.05).The internal jugular vein of most children was located at the lateral or anterolateral side of the carotid artery,and only a few children had anatomical variation.Conclusion:Compared with the traditional ultrasound guided method,the single-operator laser-assisted ultrasound guided system is an effective improvement of the traditional method.By projecting laser on the skin of children and providing a better operating condition(stable ultrasound probe),the success rate of the first guided-wire insertionf in the central vein of children aged 6 months to 6 years was significantly improved.In addition,the single-operator laser-assisted ultrasound guided method can also obtain the ideal position of the first needle tip,reduce the adjustment times of the needle tip direction,shorten the time to complete the puncture and catheterization.Thus,it improves the puncture efficiency.Moreover,the single-operator laser-assisted ultrasound system is of positive significance in avoiding the occurrence of mechanical complications during central venous catheterization in pediatric patients.