Gaber Sayed, Yehia Ahmed, Nabil Beshoy, Samir Ahmed
Critical Care Medicine, Cairo University, Giza, Egypt.
Crit Care Res Pract. 2020 Nov 3;2020:8156801. doi: 10.1155/2020/8156801. eCollection 2020.
Currently, there is no method to assess the performance while inserting a central venous catheter. We suggest a new scoring system for evaluation of both the technique as well as the operator, and then we applied it for the comparison between the landmark and ultrasound techniques to assess its validity. Four hundred patients were divided into two equal groups: group (A): internal jugular vein (IJV) and group (B): subclavian vein (SV). The landmark technique and the ultrasound guidance were used equally (100 patients for each) in both groups.
In group (A), 20% of patients in the landmark group achieved score 4, while 82% of patients in the ultrasound group achieved the same score. This suggests that the ultrasound technique for catheterization of IJV decreased overall complications and improved the success rate. In group (B), there were 70% of patients in the landmark group who achieved score 5, while 49% of patients in the ultrasound group achieved the same score which proposes that the landmark technique might be deceptively better than the ultrasound technique for catheterization of SV. This could be because the time required for catheterization of SV by the ultrasound technique was longer than that in the landmark technique. Overall complications of 15% with the landmark technique vs. 2% with ultrasound guidance in this group of patients are not only statistically significant but also increase morbidity and mortality with a highly invasive procedure. Complications and their incidences are by far more significant than seconds of time. Our results suggest that the ultrasound technique could decrease the incidence of overall complications, but it is time-consuming in group (B). These results support the validity of our new scoring system.
We suggest a new scoring system for CVC insertion that can be used for evaluation of both the technique and the operator. It can evaluate the performance of junior staff and follow their progress. It can be applied in the medical and critical care practice as well as the quality management privileges and protocols.
目前，尚无评估中心静脉导管插入操作性能的方法。我们提出一种新的评分系统，用于评估技术和操作人员，然后将其应用于对比解剖定位技术和超声引导技术，以评估其有效性。400例患者被平均分为两组：A组：颈内静脉（IJV）；B组：锁骨下静脉（SV）。两组均同等使用解剖定位技术和超声引导（每组各100例患者）。
在A组中，解剖定位组20%的患者获得4分，而超声引导组82%的患者获得相同分数。这表明超声引导下颈内静脉置管技术降低了总体并发症发生率并提高了成功率。在B组中，解剖定位组70%的患者获得5分，而超声引导组49%的患者获得相同分数，这表明解剖定位技术在锁骨下静脉置管方面可能看似比超声引导技术更好。这可能是因为超声引导技术用于锁骨下静脉置管的时间比解剖定位技术更长。在该组患者中，解剖定位技术的总体并发症发生率为15%，而超声引导下为2%，这不仅具有统计学意义，而且在这种高侵入性操作中还会增加发病率和死亡率。并发症及其发生率远比时间因素重要得多。我们的结果表明，超声引导技术可降低总体并发症发生率，但在B组中耗时较长。这些结果支持了我们新评分系统的有效性。
我们提出一种用于中心静脉导管插入的新评分系统，可用于评估技术和操作人员。它可以评估初级工作人员的操作表现并跟踪其进展。它可应用于医疗和重症监护实践以及质量管理权限和规程。
