Jia Haitao, Zhang Kai, Han Jie, Liu Qi, Chen Peizhang, Wang Yingbin, Huang Shenghui
Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
J Vasc Access. 2023 Nov;24(6):1332-1339. doi: 10.1177/11297298221086186. Epub 2022 Mar 31.
Inserting a J-tip guide-wire into a vein's lumen is often difficult when using the Seldinger or modified Seldinger technique for central venous catheterization (CVC) in newborns. This study was designed to compare the efficacy and safety of guide-wire insertion using the combination of a short peripheral intravenous cannula with a straight-tip guide-wire vs. a needle with a J-tip guide-wire for ultrasound-guided (USG) cannulation of the internal jugular vein (IJV) in newborns using an in-plane technique.
One hundred and thirty newborn patients (weight, 1.4-5.2 kg) scheduled for selective or emergency surgery, were randomly assigned to either the needle group (combined with a J-tip guide-wire) or cannula group (combined with a straight-tip guide-wire). The primary outcome was the rate of successful guide-wire insertion on the first attempt. The puncture attempts, catheter placement attempts, and mechanical complications were also compared between the groups.
The rate of successful guide-wire insertion on the first attempt was higher in the cannula group (97%) than in the needle group (76%) ( < 0.05, = 11.233). Moreover, fewer insertion attempts were needed in the cannula group (1.0 ± 0.2) than in the needle group (1.7 ± 1.1) ( < 0.05, 95% CI [0.449, 1.028]). The time to successful guide-wire insertion was shorter in the cannula group (63 ± 32 s) than in the needle group (92±50 s) ( < 0.05, 95% CI [14.024, 43.063]). No differences were found about other catheterization parameters and complications between the groups.
The short peripheral cannula combined with a straight-tip guide-wire was superior to the needle combined with a J-tip guide-wire for USG newborn IJV catheterization in terms of successful guide-wire insertion on the first attempt and overall number of insertion attempts.
在新生儿中心静脉置管（CVC）采用Seldinger或改良Seldinger技术时，将J形头导丝插入静脉腔通常很困难。本研究旨在比较短外周静脉套管与直头导丝联合使用与带J形头导丝的穿刺针在平面内技术超声引导（USG）下对新生儿颈内静脉（IJV）进行置管时导丝插入的有效性和安全性。
130例计划进行择期或急诊手术的新生儿患者（体重1.4 - 5.2千克），随机分为穿刺针组（联合J形头导丝）或套管组（联合直头导丝）。主要结局是首次尝试时导丝成功插入的比率。还比较了两组之间的穿刺尝试次数、导管置入尝试次数和机械并发症。
套管组首次尝试时导丝成功插入的比率（97%）高于穿刺针组（76%）（P < 0.05，χ² = 11.233）。此外，套管组所需的插入尝试次数（1.0 ± 0.2次）少于穿刺针组（1.7 ± 1.1次）（P < 0.05，95%CI[0.449，1.028]）。套管组导丝成功插入的时间（63 ± 32秒）短于穿刺针组（92 ± 50秒）（P < 0.0五分钟，95%CI[14.E024，43.063]）。两组之间在其他置管参数和并发症方面未发现差异。
就首次尝试时导丝成功插入以及总的插入尝试次数而言，短外周套管联合直头导丝在超声引导下对新生儿IJV置管方面优于带J形头导丝的穿刺针。
