Comparison between the Traditional Landmark Method and the Real-Time Ultrasound Technique to Determine the Correct Depth of Insertion of Central Venous Catheter in Right Jugular Vein in Pediatric Neurosurgical Patients: A Randomized Controlled Trial

Background: Central venous catheterization (CVC) is essential in paediatric neurosurgical patients for monitoring and therapeutic purposes.However, determining the optimal catheter insertion depth remains a challenge due to anatomical variability and a lack of standardized guidelines.This study aimed to compare the effectiveness of a height-based ultrasound (USG)-guided technique versus the traditional anatomical landmark approach for right internal jugular vein (IJV) catheterization in children.Methods: In a prospective randomized controlled trial conducted at a tertiary care centre in North India, 126 children aged 4-12 years undergoing elective neurosurgery were randomized into two groups: Group A (landmark technique) and Group B (USG-guided, height-based formula).Outcomes assessed included insertion depth accuracy, number of attempts, insertion time, and complications.Results: The USG group demonstrated significantly greater first-attempt success (85.7% vs. 66.7%;p = 0.037) and more accurate catheter placement (variation from carina: 2.65 ± 2.60 mm vs. 3.93 ± 3.78 mm; p = 0.028).Mean insertion depth was longer in the USG group (8.82 ± 1.86 cm vs. 8.17 ± 1.51 cm; p = 0.036), and insertion time was also higher (19.98 ± 3.89 min vs. 16.06 ± 3.98 min; p < 0.001).Although not statistically significant, complication rates were lower in the USG group.Conclusion: Height-based USG guidance offers a more accurate and effective method for paediatric IJV CVC placement, improving first-attempt success and reducing malposition without increasing complications.Despite a modest increase in procedural time, USG should be considered the preferred technique in this population.