Comparison of ultrasound-guided internal jugular vein and supraclavicular subclavian vein catheterization in critically ill patients: a prospective, randomized clinical trial

Ultrasound-guided central venous catheterization around the neck: Systematic review and network meta-analysis

BACKGROUND

Ultrasound-guided central venous catheterization (CVC) has become the standard of care. However, providers use a variety of approaches, encompassing the internal jugular vein (IJV), supraclavicular subclavian vein (SupraSCV), infraclavicular subclavian vein (InfraSCV), proximal axillary vein (ProxiAV), distal axillary vein (DistalAV), and femoral vein.

OBJECTIVE

This review aimed to compare the first-pass success rate and arterial puncture rate for different approaches to ultrasound-guided CVC above the diaphragm.

METHODS

In May 2023, Embase, MEDLINE, CENTRAL, ClinicalTrials.gov, and World Health Organization International Clinical Trials Platform were searched for randomized controlled trials (RCTs) comparing the 5 CVC approaches. The Confidence in Network Meta-Analysis tool was used to assess confidence. Thirteen RCTs (4418 participants and 13 comparisons) were included in this review.

RESULTS

The SupraSCV approach likely increased the proportion of first-attempt successes compared to the other 4 approaches. The SupraSCV first-attempt success demonstrated risk ratios (RRs) > 1.21 with a lower 95% confidence interval (CI) exceeding 1. Compared to the IJV, the SupraSCV approach likely increased the first-attempt success proportion (RR 1.22; 95% confidence interval [CI] 1.06-1.40, moderate confidence), whereas the DistalAV approach reduced it (RR 0.72; 95% CI 0.59-0.87, high confidence). Artery puncture had little to no difference across all approaches (low to high confidence).

CONCLUSION

Considering first-attempt success and mechanical complications, the SupraSCV may emerge as the preferred approach, while DistalAV might be the least preferable approach. Nevertheless, head-to-head studies comparing the approaches with the greatest first attempt success should be undertaken.

A Comparison of Techniques of Internal Jugular Vein Cannulation: Anatomical Landmark, Ultrasound Guided Pre-location, and Real-Time Ultrasound Guided

OBJECTIVE

The objective of our study is to compare the success rate, duration, and incidence of complications of a right internal jugular vein (IJV) cannulation by using three different techniques.

METHODOLOGY

A randomised controlled trial was conducted at a tertiary care teaching hospital. A total of 201 patients were randomly allocated to one of the following three groups (67 in each group). Techniques were categorised as anatomical landmark technique group (Group ALT), ultrasound guided pre-location group (Group USG-Pre), and real-time ultrasound-guided technique group (Group USG-RT).

INTERVENTIONS

Central venous catheter insertion via three techniques.

RESULTS

In 138 (73.01%) patients' IJV canulated in the first attempt, USG-RT, USG-Pre, and ALT were 51 (83.6%), 44 (72.1%), and 43 (64.2%), respectively. On the other hand, 37 (19.57%) patients were required in the second attempt, while only 14 (7.40%) patients were required in the third attempt for successful IJV cannulation. The success rates, as defined in our study, were only 138 (73%) as, in 51 (27%), we cannulated in more than a single attempt or switched to another technique. We found a significant difference in preparation time in all techniques as P-value <0.05, but no significant difference was found in venous access time, cannulation time, and duration of the procedure.

CONCLUSIONS

Any technique can be used for IJV cannulation, but the most acceptable is the real-time US technique. However, no difference in the overall procedure time among all three techniques was noted, and no major incidence of complication was found.

How to improve the efficiency and the safety of real-time ultrasound-guided central venous catheterization in 2023: a narrative review

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.

Exclusion des complications des cathéters veineux centraux : Echographie versus radiographie

INTRODUCTION

The placement of central venous catheters (CVC) is a frequent procedure in intensive care. It is not devoid of complications, the diagnosis of which relied for a long time on the chest X-ray. Currently, ultrasound appears to be an interesting alternative.

AIM

To report the impact of the use of ultrasound on the time to exclusion of mechanical complications after CVC placement.

METHODS

This is a prospective, multicenter, comparative, double-blind study. Were included the patients in whom the placement of a CVC was decided. After placement, a chest X-ray was ordered and an ultrasound was performed to look for signs of misplacement and pneumothorax. The two examinations were interpreted by two different doctors. The primary endpoint between the ultrasound group and the RTX group was the time "T1" represented by the time required to exclude complications.

RESULTS

30 patients were included in our study. The mean ultrasound T1time was significantly lower than the mean radiological T1time (p=0.000). Only one case of pneumothorax was observed. It was first detected by ultrasound. For the 29 other patients, exclusion of pneumothorax was confirmed by ultrasound and chest X-ray. No misplacement type complications detected. This was confirmed by ultrasound and radiological exclusions.

CONCLUSION

Ultrasound is a faster tool than RTX in excluding mechanical complications after CVC placement. It guarantees a non-irradiating examination as efficient as chest X-ray for intensive care patients.

Implementation of Ultrasound-Guided Infraclavicular Subclavian Venous Catheterization During Anesthesia and Elective Surgery: A Prospective Observational Study at a Single Center in Lithuania

BACKGROUND Ultrasound-guided procedures have become more reliable and efficient in daily anesthesiology practice, with increased patient comfort, better antimicrobial pattern, and easer care, and can be used in routine central vein catheterization practice. The infraclavicular subclavian vein approach provides all these advandages and in some clinical scenarios ensures the only appropriate route to central vein access. Therefore, this study of 105 patients aimed to implement and evaluate the use of ultrasound-guided infraclavicular subclavian venous catheterization. MATERIAL AND METHODS We enrolled 108 patients who were scheduled for elective major abdominal surgery and had an indication for central venous access. Catheterization was done according to the developed protocol. Anesthesiologists with at least 1 year of experience in regional ultrasound-guided anesthesia participated in this study. Data were collected and compared with the existing literature. RESULTS Out of 108 patients enrolled, 3 were excluded due to unfulfilled protocol. The successful catheterization rate was 98.1%. A significant relationship with deeper and narrower vein and failure was noted. On average, the distance between the vein entry point and acoustic shadow of the clavicle was 10.45 mm, at this point the depth was 22.01 mm and the diameter of the vein was 10.74 mm. The length of catheter intratissue passage was 42.06 mm. The angle between the skin and catheter passage was 31.58°. The malposition rate was 8.7%, and no predictive factors were identified. Equations to predict vein diameter and depth were generated. Patient weight more than 119.5 kg predicted procedure failure. There were no complications. CONCLUSIONS Ultrasound-guided infraclavicular subclavian vein catheterization can be easily and safely integrated into daily clinical practice, with high success rates and low complication rates.