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Singh Y, Pratibhan M, Singh A, Depal V, Sawhney C, Gupta B. The Study of the Feasibility of Ultrasound-guided Catheterization of the Right Brachiocephalic Vein in Adult Patients: A Prospective Observational Study. J Med Ultrasound 2024; 32:143-147. [PMID: 38882630 PMCID: PMC11175376 DOI: 10.4103/jmu.jmu_57_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 06/18/2024] Open
Abstract
Background The brachiocephalic vein (BCV) is a feasible option for central venous access in the pediatric population and is rapidly developing as an alternative site for insertion of the central line in young children with faster insertion times, fewer attempts, and lower rates of complications. However, studies demonstrating the feasibility of BCV catheterization in adult patients are insufficient. The current study sought to assess the safety and effectiveness of ultrasound-guided supraclavicular right BCV cannulations in adults. Methods A linear array Ultrasound (US) probe was used to obtain a longitudinal picture of the BCV beginning at the junction of the internal jugular vein and the subclavian vein in the supraclavicular region. Under US supervision, the needle was guided into the BCV using the in-plane approach. A prospective study was performed on 80 adult patients scheduled for elective and emergency operative procedures under general anesthesia requiring a central venous catheter (CVC). Success rates and complications that occurred during catheter insertion were analyzed. Results CVC placement was successful in all adults. The procedure was successful at the first attempt in 74 cases (92.5%) and after 2 attempts in six patients (7.5%). The time to guide wire insertion was 31.26 s (19-58 s), and catheter insertion took 88.44 s (63-145 s). The mean length of catheter insertion was 10.46 cm. No complications were noted. Conclusion Ultrasound-guided supraclavicular BCV catheterization offers a new and safe method for central venous line catheterization in adults. However, larger trials and meta-analyses are needed to confirm these findings and evaluate the safety of this technique.
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Affiliation(s)
- Yudhyavir Singh
- Department of Anesthesiology, Pain Medicine and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Magesh Pratibhan
- Department of Critical Care, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
| | - Abhishek Singh
- Department of Anesthesiology, Pain Medicine and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Vini Depal
- Department of Anesthesiology, Pain Medicine and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Chhavi Sawhney
- Department of Anesthesiology, Pain Medicine and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Babita Gupta
- Department of Anesthesiology, Pain Medicine and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
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Green ML, Kim Y, Hendel S, Groombridge CJ, Fitzgerald M. Review article: Feasibility of brachiocephalic vein central venous access for the resuscitation of shocked adult trauma patients: A literature review. Emerg Med Australas 2024; 36:6-12. [PMID: 37932025 DOI: 10.1111/1742-6723.14332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023]
Abstract
Venous access is a key component of managing haemorrhagic shock. Obtaining intravenous access in trauma patients is challenging due to circulatory collapse in shock. This literature review examines the feasibility of direct puncture and cannulation of the brachiocephalic veins (BCVs) for intravenous access in shocked adult trauma patients. Three literature searches were conducted. OVID Medline was searched for articles on the use of the BCVs for venous access in adults and on the BCVs in shock. A third systematic search of OVID Medline, OVID Embase and Cochrane Library was conducted on the use of the BCVs for access in shocked trauma patients. After full-text review, 18 studies were selected for inclusion for the search on the use of the BCVs for access in adults. No studies met the inclusion criteria for the search on the BCVs in shock and BCV access in shocked trauma patients. The BCVs are currently used for central venous access, haemodialysis and totally implantable venous access devices (TIVADs) in adults. There is a preference for the right BCV (RBCV) over the left as the RBCV is more superficial, straighter, larger, has less anatomical variation and avoids the risk of thoracic duct puncture. The BCVs appear to be stabilised in shock by surrounding bony structures. The BCVs may provide a site for initial, rapid access in trauma resuscitation. Further research is required to determine if the BCVs collapse in shock and if venous access using the BCVs is feasible in a trauma resuscitation setting.
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Affiliation(s)
- Madeline L Green
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Yesul Kim
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Simon Hendel
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
- Trauma Service, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher J Groombridge
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
- Trauma Service, Alfred Health, Melbourne, Victoria, Australia
| | - Mark Fitzgerald
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
- Trauma Service, Alfred Health, Melbourne, Victoria, Australia
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Boulet N, Muller L, Rickard CM, Lefrant JY, Roger C. How to improve the efficiency and the safety of real-time ultrasound-guided central venous catheterization in 2023: a narrative review. Ann Intensive Care 2023; 13:46. [PMID: 37227571 PMCID: PMC10212873 DOI: 10.1186/s13613-023-01141-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023] Open
Abstract
Central venous catheterization (CVC) is a frequent procedure, practiced by intensivists, anesthesiologists and advanced practice nurses in intensive care units and operative rooms. To reduce CVC-associated morbidity, it is essential to strive for best practices, based on the latest evidence. This narrative review aims to synthesize current knowledge on evidence-based best practices for CVC that improve the use and feasibility of real-time ultrasound-guided insertion procedures. Optimization of the vein puncture technique and the development of new technologies are discussed to reinforce the use of the subclavian vein catheterization as first choice. The search for alternative site of insertions, without increasing infectious and thrombotic risks, deserves further research.
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Affiliation(s)
- Nicolas Boulet
- Department of Anesthesiology, Critical Care, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Place du Professeur Debré, Gard, 30900, Nîmes, France.
- IMAGINE, UR-UM 103, University of Montpellier, Nîmes University Hospital, Nîmes, France.
| | - Laurent Muller
- Department of Anesthesiology, Critical Care, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Place du Professeur Debré, Gard, 30900, Nîmes, France
- IMAGINE, UR-UM 103, University of Montpellier, Nîmes University Hospital, Nîmes, France
| | - Claire M Rickard
- School of Nursing, Midwifery, and Social Work & Herston Infectious Diseases Institute, The University of Queensland & Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Jean-Yves Lefrant
- Department of Anesthesiology, Critical Care, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Place du Professeur Debré, Gard, 30900, Nîmes, France
- IMAGINE, UR-UM 103, University of Montpellier, Nîmes University Hospital, Nîmes, France
| | - Claire Roger
- Department of Anesthesiology, Critical Care, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Place du Professeur Debré, Gard, 30900, Nîmes, France
- IMAGINE, UR-UM 103, University of Montpellier, Nîmes University Hospital, Nîmes, France
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Haberman D, Rizhamadze L, Shaburishvili G, O'Sullivan G, Tuvali O, Jonas M, George J, Shimoni S, Abraham WT. Development of New Technique for Ultrasound Imaging of the Innominate Vein and the Venous Angle. J Am Soc Echocardiogr 2022; 35:1188-1190. [PMID: 35973560 DOI: 10.1016/j.echo.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 05/31/2022] [Accepted: 07/31/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Dan Haberman
- Heart Center, Kaplan Medical Center, Israel. Affiliated to the Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel.
| | | | | | - Gerry O'Sullivan
- Department of Interventional Radiology, University College Hospital of Galway, National University of Ireland, Galway, Ireland
| | - Ortal Tuvali
- Heart Center, Kaplan Medical Center, Israel. Affiliated to the Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Michael Jonas
- Heart Center, Kaplan Medical Center, Israel. Affiliated to the Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Jacob George
- Heart Center, Kaplan Medical Center, Israel. Affiliated to the Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Sara Shimoni
- Heart Center, Kaplan Medical Center, Israel. Affiliated to the Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
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