Comparison of ultrasound guided brachiocephalic and internal jugular vein cannulation in critically ill children
Comparison of ultrasound guided brachiocephalic and internal jugular vein cannulation in critically ill children
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DOI：
10.1016/j.jcrc.2016.05.010
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发表时间：
2016-10-01
影响因子：
3.7
通讯作者：
Rodriguez-Nunez, Antonio
中科院分区：
文献类型：
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作者：
Oulego-Erroz, Ignacio;Munoz-Lozon, Ana;Rodriguez-Nunez, Antonio
目的：确定在危重儿童紧急插入临时中心静脉导管（CVC）时，超声（US）引导的纵向头臂静脉（BCV）平面内锁骨上插管与横向颈内静脉（IJV）插管相比是否可以提高插管成功率。材料和方法：在儿科重症监护室（PICU）进行的前瞻性开放试点（非随机）比较研究某大学附属医院。入住 PICU 的新生儿和 0 至 14 岁儿童，如果临床上有紧急 CVC 指征，并按照美国指导将其插入 IJV 或 BCV，则符合资格。比较 IJV 和 BCV 技术的首次尝试成功率、总体成功率、穿刺尝试次数和插管时间。结果：纳入 38 名患者的 46 例手术（24 例 IJV 和 22 例 BCV）。全样本年龄和体重中位数（范围）分别为 13 (0.6-160) 个月和 9.5 (0.94-50) 公斤。 IJV 组和 BCV 组之间在性别、年龄、体重、入院诊断、术中机械通气和镇静方案方面没有观察到显着差异。 BCV 组的首次尝试成功率高于 IJV 组（73% vs 37.5%，P=.017）。 BCV 组的总体成功率略高（95% vs 83%，P= 无显着性）。 BCV 组的插管尝试中位（范围）次数 [1 (1-3) vs 2 (1-4)] 和插管时间 [66 (25-300) vs 170 (40-500) 秒] 显着较低 (Pb.05)。在 IJV 组中，患者体重与插管尝试次数（Pearson 系数 - 0.537，P = .007）和插管时间（Pearson 系数 - 0.495，P = .014）呈负相关，但 BCV 组则不然。未观察到重大并发症。 结论：与超声引导的平面外 IJV 相比，超声引导的锁骨上平面内 BCV 插管提高了危重儿童首次尝试 CVC 插管的成功率，并减少了穿刺尝试和插管时间。有必要进行大型随机临床试验来证实我们的结果。 (C) 2016 Elsevier Inc. 保留所有权利。
Purpose: To determine whether ultrasound (US)-guided longitudinal in-plane supraclavicular cannulation of the brachiocephalic vein (BCV) improves cannulation success rates compared to transverse out-of-plane internal jugular vein (IJV) cannulation in urgent insertion of temporary central venous catheters (CVC) in critically ill children.Materials and methods: Prospective open pilot (non-randomized) comparative study carried out in a pediatric intensive care unit (PICU) of a university-affiliated hospital. Newborns and children aged 0 to 14 years admitted to the PICU in whom an urgent CVC was clinically indicated and was inserted in the IJV or BCV by US guidance were eligible. First-attempt success rate, overall success rate, number of puncture attempts, and cannulation time were compared between IJV and BCV techniques.Results: Forty-six procedures (24 IJV and 22 BCV) in 38 patients were included. Full-sample median (range) age and weight were 13 (0.6-160) months and 9.5 (0.94-50) kg. No significant differences between IJV and BCV groups were observed for sex, age, weight, admission diagnosis, intra-procedural mechanical ventilation and sedation protocol. First attempt success rate was higher in the BCV than the IJV group (73 vs 37.5%, P=.017). Overall success rate was slightly higher in the BCV group (95 vs 83%, P= nonsignificant). Median (range) number of cannulation attempts [1 (1-3) vs 2 (1-4)] and cannulation time [66 (25-300) vs 170 (40-500) seconds] were significantly lower in the BCV group (Pb.05). Patient's weight was inversely related to the number of cannulation attempts (Pearson coefficient-0.537, P=.007) and cannulation time (Pearson coefficient-0.495, P=.014) in the IJV but not in the BCV group. No major complications were observed.Conclusions: Ultrasound-guided supraclavicular in-plane BCV cannulation improved first attempt CVC cannulation success rates and reduced puncture attempts and cannulation time compared to US-guided out-of-plane IJV in critically ill children. A large randomized clinical trial is warranted to confirm our results. (C) 2016 Elsevier Inc. All rights reserved.