Department of Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Department of Interventional Medicine, Health Center, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Ann Palliat Med. 2021 Nov;10(11):11721-11732. doi: 10.21037/apm-21-3163.
Vascular punctures are widely used in clinical applications; however, clinical trials have identified complications and poor prognosis for patients undergoing common peripheral vein puncture as compared to ultrasound-guided peripheral venipuncture and catheterization. Ultrasound-guided peripheral venipuncture and catheterization is accurate, simple, has fewer associated complications, and will gradually take the place of common peripheral vein puncture.
To study the safety of ultrasound-guided peripheral venous catheterization, a meta-analysis was conducted of relevant articles dating from establishment date of the database (such as PubMed, MEDLINE and EMBASE) to March 2021, with the search keywords being peripheral venipuncture, ultrasound guidance, vascular injury rate, and hematoma formation rate. A total of 8 trials were used to determine accuracy indicators, which included puncture failure rate, arterial injury rate, hematoma formation rate, pneumothorax incidence rate, and hemothorax incidence rate.
There were statistically significant differences between the two methods for peripheral venipuncture and catheterization in terms of puncture failure rate [odds ratio (OR) =0.08; 95% CI: 0.04-0.16; P<0.00001], incidence of vascular injury (OR =0.15; 95% CI: 0.07-0.32; P<0.00001), probability of hematoma formation during the puncture process (OR =0.24; 95% CI: 0.08-0.69; P=0.008), and probability of pneumothorax during puncture (OR =0.10; 95% CI: 0.02-0.55; P=0.008).
Eight articles were included for meta-analysis. Ultrasound-guided peripheral venipuncture and catheterization is a commonly used puncture method for patients needing rapid fluid infusion with pressure or a pressure pump, repeated transfusion of blood product, or multiple daily venous blood drawing test. The results were very clear, and the puncture failure rate and other complications of ultrasound-guided peripheral venipuncture catheterization were low.
血管穿刺在临床应用中广泛使用；然而，临床试验发现，与超声引导下外周静脉穿刺和置管相比，普通外周静脉穿刺会导致患者出现并发症和预后不良。超声引导下外周静脉穿刺和置管准确、简单，相关并发症较少，将逐渐取代普通外周静脉穿刺。
为了研究超声引导下外周静脉置管的安全性，对建库日期（如 PubMed、MEDLINE 和 EMBASE）至 2021 年 3 月的相关文献进行了荟萃分析，检索词为外周静脉穿刺、超声引导、血管损伤率和血肿形成率。共有 8 项试验用于确定准确性指标，包括穿刺失败率、动脉损伤率、血肿形成率、气胸发生率和血胸发生率。
在穿刺失败率[比值比（OR）=0.08；95%置信区间（CI）：0.04-0.16；P<0.00001]、血管损伤发生率（OR=0.15；95%CI：0.07-0.32；P<0.00001）、穿刺过程中血肿形成概率（OR=0.24；95%CI：0.08-0.69；P=0.008）和穿刺过程中气胸发生率（OR=0.10；95%CI：0.02-0.55；P=0.008）方面，两种方法存在统计学差异。
纳入 8 篇文章进行荟萃分析。超声引导下外周静脉穿刺置管术是需要快速输液加压或使用输液泵、反复输血制品、或每天多次静脉采血试验的患者常用的穿刺方法。结果非常明确，超声引导下外周静脉穿刺置管术的穿刺失败率和其他并发症发生率较低。
