Ultrasound-guided infraclavicular axillary vein cannulation: - is it a good alternative to internal jugular vein in pediatric cardiac surgery?

INTRODUCTION: This study was designed to compare the rate of successful first attempt and mechanical complications between internal jugular vein (IJV) and axillary vein (AXV) cannulation. METHODS: This prospective, randomized, comparative, controlled study included 220 pediatric patients with age range 1 to 12 years admitted for cardiac surgery. Patients were allocated into 2 equal groups, IJV group and AXV group. The main collected data were the rate of successful first, second and third punctures attempts and the rate of mechanical complications (arterial puncture, pneumothorax, catheter occlusion, catheter malposition, nerve injury). RESULTS: There was no statistically significant difference (P=0.053) in the first skin puncture success rate in both groups (AXV group 80% and IJV group 68%). There were no significant differences as regard the second and third skin punctures success rates. The incidence of failed vein puncture was similar (P=1.000) in IJV (3%) and AXV (2%) groups. The vein puncture and catheter insertion times were comparable in both groups. The rates of arterial puncture, pneumothorax and catheter malposition were similar in IJV and AXV groups (12% vs 11%, 4% vs 1%, 3% vs 5% respectively). Catheter occlusion with sternal retraction was significantly higher (p=0.029) in AXV than IJV group (6% vs 0%). No patient developed postoperative phrenic (IJV group) or brachial plexus nerve injury (AXV group). DISCUSSION AND CONCLUSION: Ultrasound-guided cannulation of both infraclavicular AXV and IJV were similarly associated with high success rate and low incidence of mechanical complications.

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Safety and efficacy of the oblique-axis plane in ultrasound-guided internal jugular vein puncture: A meta-analysis

Journal of International Medical Research ◽

10.1177/0300060518765344 ◽

2018 ◽

Vol 46 (7) ◽

pp. 2587-2594 ◽

Cited By ~ 4

Author(s):

Shuai Miao ◽

Xiuli Wang ◽

Lan Zou ◽

Ye Zhao ◽

Guanglei Wang ◽

...

Keyword(s):

Clinical Trials ◽

Success Rate ◽

Internal Jugular Vein ◽

Randomized Clinical Trials ◽

Jugular Vein ◽

Meta Analysis ◽

Short Axis ◽

Ultrasound Guided ◽

Safety And Efficacy ◽

First Pass

Objective This meta-analysis was performed to evaluate the safety and efficacy of the oblique-axis plane in ultrasound-guided internal jugular vein puncture. Methods We searched Embase, PubMed, the Cochrane Library, Web of Science, and China National Knowledge Infrastructure for relevant randomized clinical trials comparing the oblique axis with the short axis in ultrasound-guided internal jugular vein puncture. Results Five randomized clinical trials were included in this meta-analysis. The pooled meta-analysis showed that the incidence of arterial puncture in the oblique-axis group was significantly lower than that in the short-axis group. No significant difference was found in the first-pass success rate between the oblique-axis group and short-axis group. Additionally, there were no significant differences in the puncture success rate or number of attempts required between the two groups. Conclusion Ultrasound-guided internal jugular vein puncture using the oblique-axis plane reduced the risk of arterial puncture, but no difference was found in the first-pass success rate, puncture success rate, or number of attempts required.

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Comparison of short and long axis ultrasound-guided approaches to internal jugular vein puncture: a meta-analysis

Journal of International Medical Research ◽

10.1177/0300060519867806 ◽

2019 ◽

Vol 47 (9) ◽

pp. 4069-4082 ◽

Cited By ~ 2

Author(s):

Jian Zhang ◽

Xiaohan Wang ◽

Shuai Miao ◽

Mengzhu Shi ◽

Guanglei Wang ◽

...

Keyword(s):

Success Rate ◽

Internal Jugular Vein ◽

Sequential Analysis ◽

Jugular Vein ◽

Meta Analysis ◽

Cochrane Library ◽

Trial Sequential Analysis ◽

Ultrasound Guided ◽

Dichotomous Data ◽

Standard Mean Difference

Objective To compare short-axis versus long-axis plane for ultrasound-guided internal jugular vein puncture. Methods PubMed, Embase, Cochrane Library and CNKI databases were searched for randomized controlled trials, published to 1 June 2019, that compared short- versus long-axis plane in ultrasound-guided internal jugular vein puncture. Statistical analyses were performed using RevMan software, version 5.3. Statistical results are presented as risk ratio (RR) (95% confidence interval [CI]) for dichotomous data and standard mean difference (SMD) (95% CI) for continuous data. Results Ten studies fulfilled the inclusion criteria. Analyses of pooled results showed no statistically significant differences in arterial puncture incidence between the two planes (RR 0.73 [95% CI 0.38, 1.39]). First-pass success rate (RR 1.08 [95% CI 0.95, 1.22]), total success rate (RR 1.00 [95% CI 0.99, 1.02]) and number of attempts required (SMD –0.09 [95% CI –0.37, 0.18]) were also similar between the two approaches. Trial sequential analysis indicated that the available evidence was insufficient to detect potential differences between the two techniques. Conclusions There is insufficient data for an evidence-based choice of either short- or long-axis plane in ultrasound-guided internal jugular vein puncture.

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Echogenic Technology Improves Cannula Visibility during Ultrasound-Guided Internal Jugular Vein Catheterization via a Transverse Approach

Critical Care Research and Practice ◽

10.1155/2012/306182 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5

Author(s):

Konstantinos Stefanidis ◽

Nicos Pentilas ◽

Stavros Dimopoulos ◽

Serafim Nanas ◽

Richard H. Savel ◽

...

Keyword(s):

Real Time ◽

Internal Jugular Vein ◽

Jugular Vein ◽

Central Venous Access ◽

Randomized Study ◽

Venous Access ◽

Access Time ◽

Ultrasound Guided ◽

Bootstrap Analysis ◽

Mechanical Complications

Objective.Echogenic technology has recently enhanced the ability of cannulas to be visualized during ultrasound-guided vascular access. We studied whether the use of an EC could improve visualization if compared with a nonechogenic vascular cannula (NEC) during real-time ultrasound-guided internal jugular vein (IJV) cannulation in the intensive care unit (ICU).Material and Methods.We prospectively enrolled 80 mechanically ventilated patients who required central venous access in a randomized study that was conducted in two medical-surgical ICUs. Forty patients underwent EC and 40 patients were randomized to NEC. The procedure was ultrasound-guided IJV cannulation via a transverse approach.Results.The EC group exhibited increased visibility as compared to the NEC group (88% ± 8% versus 20% ± 15%, resp.P<0.01). There was strong agreement between the procedure operators and independent observers (k=0.9; 95% confidence intervals assessed by bootstrap analysis = 0.87–0.95;P<0.01). Access time (5.2 s ± 2.5 versus 10.6 s ± 5.7) and mechanical complications were both decreased in the EC group compared to the NEC group (P<0.05).Conclusion.Echogenic technology significantly improved cannula visibility and decreased access time and mechanical complications during real-time ultrasound-guided IJV cannulation via a transverse approach.

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