Gawda Ryszard, Czarnik Tomasz, Weron Rafal, Nowotarski Jakub
Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Opole - Poland.
Department of Operations Research, Wroclaw University of Technology, Wroclaw - Poland.
J Vasc Access. 2016 May 7;17(3):273-8. doi: 10.5301/jva.5000504. Epub 2016 Feb 5.
We developed the new technique of the axillary vein catheterization, which is connected with the determination of only two anatomical points of reference for puncture site identification. The primary outcome of this study was to determine the rate of successful catheterizations and the assessment of procedure success rate, depending on cannulation side as well as physician experience. The secondary objective was to evaluate the early complication rate and to determine whether this method can be used in clinical practice.
The methodology of this prospective, cohort study included catheterization of the axillary vein via the infraclavicular approach. All procedures were performed by the first two authors, each of whom had different levels of experience with the technique. The choice of the cannulation side was based on clinical factors, and the technique was identical on the right and left sides.
The cannulation success rate reached 85.6% (N = 153). The correlation between physician experience and the procedure success rate as well as between cannulation side and procedure success rate were not significant. A common early complication was a puncture of axillary artery (14.4%) with the following proper cannulation in the majority of patients (77.3%, p<0.01, exact test).
The procedure success rate, 85.6% (95% CI [80.0, 91.2%]), is comparable to other landmark-based techniques of the central vein cannulation. The moderately high percentage of axillary artery puncture points out that the approach should be used only as an alternative method to the central vein catheterization.
我们开发了一种新的腋静脉置管技术，该技术仅通过确定两个解剖参考点来识别穿刺部位。本研究的主要结果是确定置管成功率以及根据置管侧和医生经验评估操作成功率。次要目标是评估早期并发症发生率，并确定该方法是否可用于临床实践。
这项前瞻性队列研究的方法包括经锁骨下途径进行腋静脉置管。所有操作均由前两位作者进行，他们对该技术的经验水平不同。置管侧的选择基于临床因素，左右两侧的技术相同。
置管成功率达到85.6%（N = 153）。医生经验与操作成功率之间以及置管侧与操作成功率之间的相关性均不显著。常见的早期并发症是腋动脉穿刺（14.4%），大多数患者随后进行了正确置管（77.3%，p<0.01，确切检验）。
操作成功率为85.6%（95%可信区间[80.0，91.2%]），与其他基于体表标志的中心静脉置管技术相当。腋动脉穿刺的比例中等偏高，表明该方法仅应用作中心静脉置管的替代方法。
