Kim Eun-Hee, Kang Pyoyoon, Song In Sun, Ji Sang-Hwan, Jang Young-Eun, Lee Ji-Hyun, Kim Hee-Soo, Kim Jin-Tae
From the Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea (E-H K, PK, ISS, S-HJ, Y-EJ, J-HL, H-SK, J-TK) and Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea (H-SK, J-TK).
Eur J Anaesthesiol. 2022 Aug 1;39(8):656-661. doi: 10.1097/EJA.0000000000001695. Epub 2022 Jul 7.
Central venous catheterisation in neonates and infants is challenging because of the small size of the vessels. The curve of the J-tip guidewire causes difficulty when inserting because of the larger radius and the tilted angle of the J-tip.
We hypothesised that a straight-tip guidewire can facilitate guidewire insertion and improve the first-attempt success rate of central venous catheterisation.
A randomised controlled study.
This study was performed between September 2018 and July 2021 in tertiary care children's hospital.
We enrolled infants weighing less than 5 kg undergoing general anaesthesia.
Patients were randomly allocated to the straight-tip or J-tip groups. Ultrasonography-guided catheterisation was performed using the assigned guidewire.
The primary outcome was the first-attempt success rate of central venous catheterisation. The secondary outcomes included the number of guidewire insertion attempts, the time required for successful guidewire insertion, and total time for central venous catheter placement.
Eighty-eight patients were studied. The straight-tip group showed a higher first attempt success rate than the J-tip group (86.3 vs. 61.3%, P = 0.007, odds ratio 4.0, 95% confidence interval (CI), 1.4 to 11.4]. Guidewire insertion attempts were higher in the J-tip group than in the straight group ( P = 0.002, odds ratio 9.6, 95% CI, 7.9 to 92.9). Although the guidewire insertion time was longer in the J-tip group ( P = 0.003, median difference 23.0 s, 95% CI, 7.0 to 48.0), the total catheterisation time was similar owing to the additional guidewire change process in the straight-tip group ( P = 0.676).
In neonates or infants weighing less than 5 kg, central venous catheterisation using a flexible straight-tip guidewire can improve the first-attempt success rate compared with a J-tip guidewire.
ClinicalTrials.gov, identifier: NCT03530618.
由于新生儿和婴儿血管细小，中心静脉置管具有挑战性。J形头导丝因半径较大且J形头倾斜角度，在插入时会造成困难。
我们假设直头导丝可便于导丝插入并提高中心静脉置管的首次尝试成功率。
一项随机对照研究。
本研究于2018年9月至2021年7月在一家三级护理儿童医院进行。
我们纳入了体重小于5千克且接受全身麻醉的婴儿。
患者被随机分配至直头组或J形头组。使用指定导丝进行超声引导下的置管。
主要结局是中心静脉置管的首次尝试成功率。次要结局包括导丝插入尝试次数、成功插入导丝所需时间以及中心静脉置管的总时间。
共研究了88例患者。直头组的首次尝试成功率高于J形头组（86.3%对61.3%，P = 0.007，优势比4.0，95%置信区间（CI），1.4至11.4）。J形头组的导丝插入尝试次数高于直头组（P = 0.002，优势比9.6，95%CI，7.9至92.9）。尽管J形头组的导丝插入时间更长（P = 0.003，中位数差值23.0秒，95%CI，7.0至48.0），但由于直头组有额外的导丝更换过程，总置管时间相似（P = 0.676）。
对于体重小于5千克的新生儿或婴儿，与J形头导丝相比，使用可弯曲直头导丝进行中心静脉置管可提高首次尝试成功率。
ClinicalTrials.gov，标识符：NCT03530618。
