Camkiran Firat Aynur, Zeyneloglu Pinar, Ozkan Murat, Pirat Arash
1Department of Anesthesiology, Baskent University Faculty of Medicine, Ankara, Turkey. 2Department of Cardiovascular Surgery, Baskent University Faculty of Medicine, Ankara, Turkey.
Pediatr Crit Care Med. 2016 Sep;17(9):e413-9. doi: 10.1097/PCC.0000000000000878.
To compare internal jugular vein and subclavian vein access for central venous catheterization in terms of success rate and complications.
A 1:1 randomized controlled trial.
Baskent University Medical Center.
Pediatric patients scheduled for cardiac surgery.
Two hundred and eighty children undergoing central venous catheterization were randomly allocated to the internal jugular vein or subclavian vein group during a period of 18 months.
The primary outcome was the first-attempt success rate of central venous catheterization through either approach. The secondary outcomes were the rates of infectious and mechanical complications. The central venous catheterization success rate at the first attempt was not significantly different between the subclavian vein (69%) and internal jugular vein (64%) groups (p = 0.448). However, the overall success rate was significantly higher through the subclavian vein (91%) than the internal jugular vein (82%) (p = 0.037). The overall frequency of mechanical complications was not significantly different between the internal jugular vein (25%) and subclavian vein (31%) (p = 0.456). However, the rate of arterial puncture was significantly higher with internal jugular vein (8% vs 2%; p = 0.03) and that of catheter malposition was significantly higher with subclavian vein (17% vs 1%; p < 0.001). The rates per 1,000 catheter days for both positive catheter-tip cultures (26.1% vs 3.6%; p < 0.001) and central-line bloodstream infection (6.9 vs 0; p < 0.001) were significantly higher with internal jugular vein. There were no significant differences between the groups in the length of ICU and hospital stays or in-hospital mortality rates (p > 0.05 for all).
Central venous catheterization through the internal jugular vein and subclavian vein was not significantly different in terms of success at the first attempt. Although the types of mechanical complications were different, the overall rate was similar between internal jugular vein and subclavian vein access. The risk of infectious complications was significantly higher with internal jugular vein access.
比较颈内静脉和锁骨下静脉穿刺置管行中心静脉导管插入术的成功率及并发症情况。
1:1随机对照试验。
巴斯肯特大学医学中心。
计划行心脏手术的儿科患者。
在18个月的时间里，280例行中心静脉导管插入术的儿童被随机分配至颈内静脉组或锁骨下静脉组。
主要结局指标是两种途径行中心静脉导管插入术首次尝试的成功率。次要结局指标是感染性和机械性并发症的发生率。锁骨下静脉组（69%）和颈内静脉组（64%）首次尝试行中心静脉导管插入术的成功率无显著差异（p = 0.448）。然而，锁骨下静脉途径的总体成功率（91%）显著高于颈内静脉途径（82%）（p = 0.037）。颈内静脉组（25%）和锁骨下静脉组（31%）机械性并发症的总体发生率无显著差异（p = 0.456）。然而，颈内静脉穿刺动脉的发生率显著更高（8% 对比2%；p = 0.03），锁骨下静脉导管错位的发生率显著更高（17% 对比1%；p < 0.001）。颈内静脉导管尖端培养阳性率（26.1% 对比3.6%；p < 0.001）和中心静脉导管相关血流感染率（6.9对比0；p < 0.001）每1000导管日的发生率均显著高于锁骨下静脉。两组在重症监护病房住院时间、住院时间或院内死亡率方面无显著差异（所有p > 0.05）。
颈内静脉和锁骨下静脉穿刺置管行中心静脉导管插入术首次尝试的成功率无显著差异。尽管机械性并发症的类型不同，但颈内静脉和锁骨下静脉途径的总体发生率相似。颈内静脉途径发生感染性并发症的风险显著更高。
