Maitra Souvik, Bhattacharjee Sulagna, Baidya Dalim K
Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, New Delhi, India.
Department of Anaesthesia & Critical Care, Institute of Liver & Biliary Sciences, New Delhi, India.
J Vasc Access. 2020 Mar;21(2):204-209. doi: 10.1177/1129729819868927. Epub 2019 Aug 18.
Comparison between various approaches of ultrasound (USG)-guided internal jugular vein cannulation, that is, short-axis out-of-plane approach, long-axis in-plane approach, and oblique-axis approach, is sparse. In this network meta-analysis of randomized controlled trials, all three approaches were evaluated to identify the best technique for USG-guided internal jugular vein cannulation.
Randomized controlled trials comparing short-axis out-of-plane approach, long-axis in-plane approach, and oblique-axis approach in any combination (i.e. comparison of any two or all three) for USG-guided internal jugular vein cannulation were included in this meta-analysis. Bayesian network meta-analysis was conducted with a non-informative prior effect size and heterogeneity, and all results were reported as posterior median odds ratio with 95% credible interval.
Data of 658 patients from five randomized controlled trials were included in this meta-analysis. No difference was obtained in first attempt success rate of cannulation in three approaches (posterior median odds ratio between long-axis and short-axis view, oblique-axis and short-axis view, and long-axis and oblique-axis view were 0.67 (0.20, 2.08), 0.92 (0.09, 4.790), and 1.3420 (0.1680, 6.7820), respectively). No difference was seen in the incidence of carotid artery puncture and overall success rate of cannulation.
All three commonly used approaches for USG-guided internal jugular vein cannulation, that is, short axis, long axis, and oblique axis, are comparable in terms of clinical utility and safety. There is insufficient evidence to recommend one approach over another for this purpose.
超声（USG）引导下颈内静脉置管的各种方法，即短轴平面外进针法、长轴平面内进针法和斜轴进针法之间的比较较少。在这项随机对照试验的网络荟萃分析中，对所有这三种方法进行了评估，以确定USG引导下颈内静脉置管的最佳技术。
本荟萃分析纳入了比较短轴平面外进针法、长轴平面内进针法和斜轴进针法以任何组合方式（即任意两种或全部三种的比较）用于USG引导下颈内静脉置管的随机对照试验。采用非信息性先验效应大小和异质性进行贝叶斯网络荟萃分析，所有结果均报告为后验中位数优势比及95%可信区间。
本荟萃分析纳入了来自五项随机对照试验的658例患者的数据。三种方法的首次置管成功率无差异（长轴与短轴视图、斜轴与短轴视图、长轴与斜轴视图之间的后验中位数优势比分别为0.67（0.20，2.08）、0.92（0.09，4.790）和1.3420（0.1680，6.7820））。颈动脉穿刺发生率和置管总体成功率无差异。
USG引导下颈内静脉置管的所有三种常用方法，即短轴、长轴和斜轴，在临床实用性和安全性方面具有可比性。目前没有足够的证据推荐一种方法优于另一种方法用于此目的。
