Arya Vikas, Gupta Devendra, Agarwal Anil, Paul Mekhala, Mishra Prabhaker
Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
J Anaesthesiol Clin Pharmacol. 2020 Jan-Mar;36(1):57-61. doi: 10.4103/joacp.JOACP_305_18. Epub 2020 Feb 18.
We devised a guard which can be slid and fixed over the central venous puncture needle at a desired length (measured through ultrasound) preventing the needle from penetrating deeper into the skin beyond this guard. This randomized, single blinded, controlled study was designed to evaluate the success of ultrasound guided internal jugular vein (IJV) cannulation using measured guided needle with guard in terms of success and occurrence of complications.
After ethical approval and written informed consent from the patients ultrasound-guided right-sided IJV cannulation was done with a conventional puncture needle (length of 6.4 cm) in the control group ( = 210) and with a conventional puncture needle with a guard fixed proximal to the bevel at a distance equal to the distance between the skin entry point and the midpoint of IJV measured with the help of USG in the study group ( = 210). The primary outcome studied was the number of attempts for successful cannulation. The secondary outcomes studied were complications and ease of cannulation.
419 patients were randomized into control ( = 209) and study groups (210). Successful IJV cannulation in the first attempt (primary endpoint) in the study group was significantly higher compared to the control group (98.6 vs. 85.7%, = 0.007). Posterior venous wall puncture was reduced in the study group, that is, 0.5% (1/210) compared to control group, that is, 8.61% (18/209) ( = 0.001). Common carotid artery puncture was 7.18% (15/209) in control group and 0% (0/210) in study group ( = 0.001). Operators rated better ease in study group ( < 0.001).
The use of measured guided needle with guard significantly improved the accuracy, success and ease of USG guided IJV cannulation and decreased complications.
我们设计了一种防护装置，它可以在所需长度（通过超声测量）处滑动并固定在中心静脉穿刺针上，防止穿刺针在超出该防护装置的情况下进一步刺入皮肤。本随机、单盲、对照研究旨在评估使用带防护装置的测量导向针进行超声引导下颈内静脉（IJV）置管在成功率和并发症发生方面的效果。
在获得伦理批准并取得患者书面知情同意后，对照组（n = 210）使用传统穿刺针（长度为6.4 cm）进行超声引导下右侧IJV置管，研究组（n = 210）使用在斜面近端固定有防护装置的传统穿刺针，该防护装置与皮肤进针点和借助超声测量的IJV中点之间的距离相等。研究的主要结局是成功置管的尝试次数。研究的次要结局是并发症和置管的难易程度。
419例患者被随机分为对照组（n = 209）和研究组（210例）。研究组首次尝试成功进行IJV置管（主要终点）的比例显著高于对照组（98.6%对85.7%，P = 0.007）。研究组后静脉壁穿刺减少，即0.5%（1/210），而对照组为8.61%（18/209）（P = 0.001）。对照组颈总动脉穿刺率为7.18%（15/209），研究组为0%（0/210）（P = 0.001）。操作者对研究组置管的难易程度评价更高（P < 0.001）。
使用带防护装置的测量导向针显著提高了超声引导下IJV置管的准确性、成功率和操作便利性，并减少了并发症。
