Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea.
Minerva Anestesiol. 2021 Mar;87(3):294-301. doi: 10.23736/S0375-9393.20.14734-5. Epub 2020 Dec 15.
Continuous visualization of the needle tip is essential for successful ultrasound-guided central venous catheterization, and the dynamic needle tip positioning (DNTP) technique enables it. The aim of this randomized, dual-center trial was to compare the first-attempt success rate of ultrasound-guided internal jugular catheterization between the DNTP and conventional long-axis in-plane (LAX-IP) techniques.
Patients undergoing cardiac surgery at two tertiary teaching hospitals were randomly allocated to either the DNTP or LAX-IP group. Internal jugular venous catheterization was performed by four anesthesiologists. The primary outcome was the first-attempt success rate of central venous catheterization. Procedural time and complications related to catheterization were compared as secondary outcomes.
In total, 142 patients were analysed. The first-attempt success rate was significantly higher in the DNTP group (59/72, 81.9%) than in the LAX-IP group (46/70, 65.7%; odds ratio, 2.37; 95% confidence interval 1.09-5.15; P=0.028). In addition, the needle was redirected less frequently in the DNTP group than the LAX-IP group (P=0.026). Procedural time was comparable between the groups. No significant differences were observed in complications related to catheterization, including posterior wall puncture, carotid artery puncture, or hematoma.
The DNTP technique resulted in a significantly higher success rate on the first attempt at internal jugular venous catheterization and required less frequent redirection of the needle during the procedure than the conventional LAX-IP technique.
成功的超声引导下中心静脉置管需要持续可视化针尖，而动态针尖定位（DNTP）技术可实现这一点。本随机、双中心试验的目的是比较 DNTP 与传统长轴平面内（LAX-IP）技术在超声引导下颈内静脉置管中的首次尝试成功率。
在两家三级教学医院接受心脏手术的患者被随机分配到 DNTP 或 LAX-IP 组。由四名麻醉师进行颈内静脉置管。主要结局是中心静脉置管的首次尝试成功率。次要结局比较了操作时间和与置管相关的并发症。
共分析了 142 例患者。DNTP 组的首次尝试成功率（59/72，81.9%）明显高于 LAX-IP 组（46/70，65.7%；优势比，2.37；95%置信区间 1.09-5.15；P=0.028）。此外，DNTP 组针尖重新定向的频率明显低于 LAX-IP 组（P=0.026）。两组的操作时间无显著差异。与置管相关的并发症（包括后壁穿刺、颈动脉穿刺或血肿）无显著差异。
DNTP 技术可显著提高颈内静脉置管的首次尝试成功率，且在操作过程中针尖重新定向的频率低于传统的 LAX-IP 技术。
