Axillary vein catheterization using ultrasound guidance: A prospective randomized cross-over controlled simulation comparing standard ultrasound and new needle-pilot device

Background: Real-time ultrasound (US) guidance facilitates central venous catheterization in intensive care unit (ICU). New magnetic needle-pilot devices could improve efficiency and safety of central venous catheterization. This simulation trial was aimed at comparing venipuncture with a new needle-pilot device to conventional US technique. Methods: In a prospective, randomized, simulation trial, 51 ICU physicians and residents cannulated the right axillary vein of a human torso mannequin with standard US guidance and with a needle-pilot system, in a randomized order. The primary outcome was the time from skin puncture to successful venous cannulation. The secondary outcomes were the number of skin punctures, the number of posterior wall puncture of the axillary vein, the number of arterial punctures, the number of needle redirections, the failure rate, and the operator comfort. Results: Time to successful cannulation was shorter with needle-pilot US-guided technique (22 s (interquartile range (IQR) = 16–42) vs 25 s (IQR = 19–128); median of difference (MOD) = −9 s (95%-confidence interval (CI) −5, −22), p < 0.001). The rates of skin punctures, posterior wall puncture of axillary vein, and needle redirections were also lower ( p < 0.01). Comfort was higher in needle-pilot US-guided group on a 11-points numeric scale (8 (IQR = 8–9) vs 6 (IQR = 6–8), p < 0.001). Conclusions: In a simulation model, US-guided axillary vein catheterization with a needle-pilot device was associated with a shorter time of successful cannulation and a decrease in numbers of skin punctures and complications. The results plea for investigating clinical performance of this new device.

Bowel Evisceration Following Attempt at Umbilical Vein Catheterization in a Neonate: A Case Report

catheterization of the umbilical vein provides a quick vascular access in neonates. It is a relatively easy procedure routinely performed in neonatal intensive care units. However, this procedure may come with lots of complications. We report a rare complication of bowel evisceration from the umbilicus following an attempt to catheterize the umbilical vein. This complication may be prevented by meticulous dissection and avoidance of probing of the umbilical vein during umbilical vein catheterization.

Subclavian vein catheterization: Comparative evaluation of supraclavicular versus infraclavicular approach in oncology patients

The subclavian vein is the preferred site for central venous catheter insertion because of its several advantages. Infraclavicular is the commonly used approach while supraclavicular is less popular approach for catheterizing the subclavian vein. The aim of the study was to compare supraclavicular and infraclavicular approach of subclavian vein catheterization in terms of number of attempts, success rate, access time for catheterization and to record the complications associated with the procedure. In this study, 120 patients of inclusion criteria were placed either in group supraclavicular (SC) or group infraclavicular (IC) for subclavian vein catheterization using modified Seldinger technique under general or local anaesthesia.Chi square test was used to compare success rate and independent T test for access time of catheterization between two groups. First attempt success rate in group SC was 81.66% and in group IC was 66.66%. But overall success rate was 93.33% in group SC, whereas it was 90% in group IC. This was not statistically significant with p value of 0.5. Time taken for successful catheterization was 252.98 ± 76.27 seconds in group SC and 314.98 ± 121.28 seconds in group IC. This was statistically significant with p value of 0.001.Right brachiocephalic vein tear was the only complication in entire study which occurred in group IC. Subclavian vein catheterization via supraclavicular approach was a faster approach than infraclavicular, whereas both were comparable in terms of success rate.

Landmark-based estimation vs. linear regression model: a retrospective comparison for prediction of optimal length of right subclavian vein catheterization in infants

Background: The optimal insertion length for right subclavian vein catheterization in infants has not been determined. This study retrospectively compared landmark-based and linear regression model-based estimation of optimal insertion length for right subclavian vein catheterization in pediatric patients of corrected age < 1 year. Methods: Fifty catheterizations of the right subclavian vein were analyzed. The landmark related distances were: from the needle insertion point (I) to the tip of the sternal head of the right clavicle (A) and from A to the midpoint (B) of the perpendicular line drawn from the sternal head of the right clavicle to the line connecting the nipples. The optimal length of insertion was retrospectively determined by reviewing post-procedural chest radiographs. Estimates using a landmark-based equation (IA + AB – intercept) and a linear regression model were compared with the optimal length of insertion. Results: A landmark-based equation was determined as IA + AB – 5. The mean difference between the landmark-based estimate and the optimal insertion length was 1.0 mm (95% limits of agreement –18.2 to 20.3 mm). The mean difference between the linear regression model (26.681 – 4.014 × weight + 0.576 × IA + 0.537 × AB – 0.482 × postmenstrual age) and the optimal insertion length was 0 mm (95% limits of agreement –16.7 to 16.7 mm). The difference between the estimates using these two methods was not significant. Conclusion: A simple landmark-based equation may be useful for estimating optimal insertion length in pediatric patients of corrected age < 1 year undergoing right subclavian vein catheterization.

Ultrasound assisted catheterization of internal jugular vein

An appropriate vascular access is always needed for the success of hemodialysis. Internal jugular vein is the safest and less complicated access in between central veins. At the same time, it is the most commonly used temporary vascular access for hemodialysis. The blind method after anatomical marking for the central vascular path is the most used technique in many centers. The use of ultrasound in the placement of hemodi-alysis catheters in the central vein increases the success rate of catheterization. Ultrasound can show IJV locali-zation, anatomical variations, the presence of thrombus in the vein, and whether the vein is open. The aim of this study is to compare the success rate and complication frequency of temporary catheters placed in the IJV with and without ultrasound for hemodialysis. A total of 124 consecutive patients who required hemodialysis catheters in Haydarpaşa Numune Trai-ning and Research Hospital between February 2012 and December 2012 were randomized to the study. The patients were divided into two groups as non USG-assisted (blindly) (Group 1) and ultrasound-assisted (Group 2). The use of ultrasound significantly increased the successful catheterization rates of both experienced specialist and resident. In addition, there was no statistical difference between the success rates between the specialist and the resident. USG-assisted vein catheterization can be performed safely, easily, quickly, more painlessly and with minimal complication rates. Catheter intervention should be performed under the guidance of USG in risky patient groups who need temporary catheters. In centers that do not have USG, especially in such risky patients, blind catheter interven-tion should not be attempted after anatomical marking. USG-assisted vein catheterization can be easily perfor-med by all clinicians and residents, since the training period is short, practical and much more safe.