Ince Ilker, Arı Muhammet Ali, Sulak Muhammet Mustafa, Aksoy Mehmet
Ataturk University School of Medicine, Department of Anesthesiology and Reanimation, Erzurum, Turquia.
Ataturk University School of Medicine, Department of Anesthesiology and Reanimation, Erzurum, Turquia.
Braz J Anesthesiol. 2018 May-Jun;68(3):260-265. doi: 10.1016/j.bjan.2017.12.002. Epub 2018 Feb 23.
There are different ultrasound probe positions used for internal jugular venous catheter placement. Also, in-plane or out of plane needle approach may be used for catheterization. Transverse short-axis classic approach is the most popular performed approach in literature. “Syringe-Free” is a new described technique that is performed with oblique long-axis approach. We aimed to compare performance of these two approaches.
This study was conducted as a prospective and randomized study. 80 patients were included the study and allocated into two groups that were named Group C (transverse short-axis classic approach) and Group SF (oblique long-axis syringe-free approach) by a computer-generated randomization. The primary outcome was mean time that guidewire is seen in the Internal jugular vein (performing time). The secondary outcomes were to compare number of needle pass, number of skin puncture and complications between two groups.
Demographic and hemodynamic data were not significantly different. The mean performing time was 54.9 ± 19.1 s in Group C and 43.9 ± 15.8 s in Group SF. Significant differences were found between the groups ( = 0.006). Mean number of needle pass was 3.2 (± 2.1) in Group C and 2.1 (± 1.6) in Group SF. There were statistically significant differences between two groups ( = 0.002). The number of skin puncture was 1.6 (± 0.8) and 1.2 (± 0.5) in Group C and SF, respectively ( = 0.027).
“Syringe-Free” technique has lower performing time, number of needle pass and skin puncture. Also, it allows to follow progress of guide-wire under continuous ultrasound visualization and the procedure does not need assistance during catheter insertion. Namely, “Syringe-Free” is effective, safe and fast technique that may be used to place internal jugular venous catheter.
用于颈内静脉置管的超声探头位置各异。此外，导管插入可采用平面内或平面外进针方法。横向短轴经典方法是文献中最常用的方法。“无注射器”是一种新描述的技术，采用斜长轴方法进行。我们旨在比较这两种方法的效果。
本研究为前瞻性随机研究。80例患者纳入研究，通过计算机生成随机数分为两组，分别命名为C组（横向短轴经典方法）和SF组（斜长轴无注射器方法）。主要结局是导丝进入颈内静脉的平均时间（操作时间）。次要结局是比较两组的进针次数、皮肤穿刺次数及并发症情况。
人口统计学和血流动力学数据无显著差异。C组平均操作时间为54.9±19.1秒，SF组为43.9±15.8秒。两组间存在显著差异（P = 0.006）。C组平均进针次数为3.2（±2.1）次，SF组为2.1（±1.6）次。两组间有统计学显著差异（P = 0.002）。C组和SF组的皮肤穿刺次数分别为1.6（±0.8）次和1.2（±0.5）次（P = 0.027）。
“无注射器”技术操作时间更短、进针次数和皮肤穿刺次数更少。此外，它能在持续超声可视化下跟踪导丝进展，且导管插入过程无需协助。也就是说，“无注射器”是一种有效、安全且快速的颈内静脉置管技术。
