Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, China.
National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, China.
Acta Anaesthesiol Scand. 2021 Mar;65(3):420-427. doi: 10.1111/aas.13728. Epub 2020 Nov 20.
Rapid central venous catheterization is critical for the rescue and perioperative management of premature infants requiring surgery. Ultrasound-guided dynamic needle tip positioning (DNTP) has been widely used as a very effective technique, especially in paediatric vascular puncture and catheterization. However, for low-weight premature newborns, central vein catheterization still poses greater difficulties for paediatricians and paediatric anaesthesiologists. This prospective randomized control study aimed to evaluate the efficacy of combined short- and long-axis (CSLA) internal jugular vein catheterization for premature newborns in comparison with the DNTP technique.
A total of 90 premature newborns (gestational age < 37 weeks and < 28 days after birth) who were scheduled for surgery were included in this study. All enrolled premature newborns were randomly divided into two groups (n = 45): the CSLA group and the DNTP group. We compared the first-puncture success rate, total success rate, procedure time, number of needle passes, occurrence of complications and other outcome measures between the two groups.
The two groups (n = 45 per group) were similar in sex, gestational age, weight, mean arterial blood pressure, and vein-related measurements of the internal jugular vein. Total success was achieved in 43 (95.6%) and 36 (80.0%) patients in the CSLA and DNTP groups respectively. Compared with the DNTP group, the CSLA group showed a significantly higher first-attempt success rate (71.1% vs 46.7%, χ = 5.5533, P = .0184) and significantly fewer needle passes (1.0[1.0-2.0] vs 2.0[1.0-3.0], χ = -2.6094, P = .0091). There was no significant difference between the groups in the procedure time (368[304-573] vs 478[324-79]s, Z = -1.7690, P = .0769). Complications occurred in both groups, but the incidence was significantly lower in the CSLA group than in the DNTP group (6.7% vs 22.2%, χ = 4.4056, P = .0358).
Ultrasound-guided internal jugular vein catheterization by the CSLA method is effective and safe. The CSLA method may be superior to the DNTP technique in premature newborns.
对于需要手术的早产儿，快速进行中心静脉置管至关重要。超声引导下的动态针尖定位（DNTP）已广泛应用于非常有效的技术，尤其是在儿科血管穿刺和置管中。然而，对于低体重早产儿，中心静脉置管仍然给儿科医生和儿科麻醉师带来更大的困难。本前瞻性随机对照研究旨在评估短轴和长轴（CSLA）颈内静脉置管术与 DNTP 技术相比在早产儿中的疗效。
本研究共纳入 90 例拟行手术的早产儿（胎龄<37 周且出生后<28 天）。所有纳入的早产儿均随机分为两组（n=45）：CSLA 组和 DNTP 组。比较两组的首次穿刺成功率、总成功率、操作时间、穿刺次数、并发症发生率等。
两组（每组 n=45）在性别、胎龄、体重、平均动脉压和颈内静脉相关测量方面相似。CSLA 组和 DNTP 组的总成功率分别为 43（95.6%）和 36（80.0%）例。与 DNTP 组相比，CSLA 组首次尝试成功率显著更高（71.1%比 46.7%，χ²=5.5533，P=0.0184），穿刺次数显著更少（1.0[1.0-2.0]比 2.0[1.0-3.0]，χ²=-2.6094，P=0.0091）。两组的操作时间无显著差异（368[304-573]比 478[324-79]s，Z=-1.7690，P=0.0769）。两组均发生并发症，但 CSLA 组的发生率明显低于 DNTP 组（6.7%比 22.2%，χ²=4.4056，P=0.0358）。
超声引导下 CSLA 颈内静脉置管术有效且安全。CSLA 法可能优于 DNTP 技术在早产儿中的应用。
