Comparing open surgical, SELDINGER’S technique with surgical isolation of the vein and ultrasound guided techniques for jugular central line insertion in infants: a randomized clinical trial

Abstract

BACKGROUND: Centrally Inserted Central Catheter (CICC) placing procedure is challenging in the pediatric population, especially in newborns and infants, leading to lower success and higher complication rates than in adults. The aim of this study was to compare three approaches: open technique, SELDINGER'S technique with surgical isolation of the vein, and percutaneous ultrasound-guided CICC insertion for central line insertion in infancy as regards safety, success of cannulation, technique time, and preservation of the patency of the internal jugular vein (IJV). METHODS: This prospective randomized cohort study was conducted after approval of the Ethical Committee of Tanta University Hospital with approval code: 36264MS38/1/23 (clinical trial ID: NCT06862492 and date: 03/05/2025). This study adheres to CONSORT guidelines. This study included 105 infants in need of CVC insertion over a period of 6 months. They were randomly allocated into three equal groups; group A underwent CICC insertion using the open surgical technique, group B underwent SELDINGER'S technique with surgical isolation of the vein, and group C underwent percutaneous ultrasound-guided CICC insertion. RESULTS: Patency was significantly higher in SELDINGER'S technique with surgical isolation of the vein and percutaneous ultrasound-guided techniques compared to the open surgical technique (P = 0.003, < 0.001). There was a significant negative correlation between patency of IJV and duration of CICC placement (r = -0.238, P = 0.010) and with the number of trials to success of the cannulation (r = -0.252, P = 0.006). The technique time was significantly shorter in the percutaneous ultrasound-guided technique compared to open surgical and SELDINGER'S technique with surgical isolation of the vein (P < 0.001, < 0.001). SELDINGER'S technique with surgical isolation of the vein was a significantly shorter technique time when compared to the open surgical technique (P < 0.001). CONCLUSIONS: US-guided catheterization of the IJV shows more advantages in the form of a less time-consuming technique with a high first attempt and insertion success rate and fewer trials compared to CICC insertion using either open surgical technique or SELDINGER'S technique with surgical isolation of the vein. TRIAL REGISTRATION: Current Controlled Trials NCT06862492 and date: 03/05/2025.