Manual Compression of External Iliac Vein to Increase the Size of Femoral Vein for Femoral Central Venous Catheter Insertion in Small Children: Pilot Experimental Study and Randomized Trial
Femoral central line insertion is sometimes difficult in small children due to small vein size. Compression of external iliac vein may provide a tourniquet effect and increase femoral vein size. In this study, we showed that external iliac vein compression significantly increased femoral vein size. By average, anteroposterior diameter increased by 41%; medial-lateral diameter increased by 19%. Pediatric femoral central venous catheter insertion is sometimes difficult due to small vein size. External iliac vein (EIV) compression may provide a tourniquet effect to the femoral vein (FV) and may facilitate catheterization. This study was conducted to determine the effect of EIV compression on FV size and femoral venous catheterization success rates. This study had 2 parts. The first part was a single-arm experimental study. The second part was a randomized controlled trial. Children weighing 2.5–15.0 kg were included. First part: All patients received the same intervention and measurements. FV anteroposterior and medial-lateral diameters were measured by ultrasound without EIV compression, after which EIV was compressed using the assistant’s finger, and FV diameters were measured. Second part: Patients were randomized into compression and control groups. The compression group received EIV compression during femoral venous catheterization. The control group did not receive the compression. A total of 30 patients (15 in each group) participated. EIV compression significantly increased FV anteroposterior diameter (3.36 ± 1.01 mm with compression, 2.39 ± 0.76 mm without compression, mean difference = 0.97 mm, 95% CI = 0.73, 1.21, P < 0.001) and medial-lateral diameter (4.58 ± 1.40 mm with compression, 3.86 ± 1.32 mm without compression, mean difference = 0.72 mm, 95% CI = 0.43, 1.01, P < 0.001). Catheterization success rates were not different between groups. EIV compression increased FV size, but the effect on femoral venous catheterization success rates was inconclusive due to a small sample size.Highlights
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Manual compression of the right external iliac vein with an assistant’s finger is shown. Dotted line marks the inguinal ligament. Black dot marks expected vessel puncture site.
Patient recruitment and study flow diagram. CVC = central venous catheter.
Ultrasound images of a patient’s femoral vein (white arrows) in the short axis (A) without manual compression of external iliac vein, and (B) with manual compression of external iliac vein.
Kaplan-Meier curve showing cumulative incidence of successful central venous catheter insertion over time. CVC = central venous catheter.
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