Hashimoto Kazuki, Nawata Shintaro, Wada Shinji, Hamaguchi Shingo, Tanabe Kenichiro, Mimura Hidefumi
Department of Diagnostic Radiology and Interventional Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
Department of Frontier Medicine, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
J Vasc Access. 2025 Jul;26(4):1173-1179. doi: 10.1177/11297298241260904. Epub 2024 Aug 1.
The internal jugular vein (IJV) is one of the most used sites for central venous access. Some authors revealed the association of a higher deformation rate of the IJV wall with posterior wall penetration, which may cause a hemorrhagic complication. A newly developed thin-tip needle (three-dimensional (3D) needle) reduced the deformation rate in an ex vivo study. Therefore, we conducted a clinical study to investigate its efficacy in reducing vessel deformity during IJV puncture.
This study retrospectively enrolled 80 adult patients who received central venous port (CVP) implantation via the IJV from April 1, 2022, to November 10, 2023, in our institution. Traditional needle-and-catheter was used for ultrasound (US)-guided IJV puncture (usual group) for the former 40 patients before July 18, 2023. Afterward, the 3D needle was used for the latter 40 patients (3D needle group). US images were stored and analyzed to calculate the deformation rate.
The deformation rate was 58.6% (13.2-100) for the usual needle and 41.8% (10.6-100) for the 3D needle ( = 0.0034). Patients who required several punctures included 2 for the usual needle and 12 for the 3D needle, respectively ( = 0.0032). All patients and the usual needle group demonstrated a weak negative correlation between the deformation rate and pre-puncture vessel diameter ( = 0.24 and 0.41, respectively), with no correlation in the 3D needle group.
The deformation rate of the IJV wall was smaller in the 3D needle group than in the usual needle group. The use of a 3D needle would be safer when puncturing the IJV.
颈内静脉（IJV）是最常用于中心静脉置管的部位之一。一些作者揭示了颈内静脉壁较高的变形率与后壁穿透之间的关联，而后壁穿透可能导致出血并发症。一项体外研究表明，一种新开发的细尖针（三维（3D）针）降低了变形率。因此，我们进行了一项临床研究，以调查其在颈内静脉穿刺过程中减少血管变形的效果。
本研究回顾性纳入了2022年4月1日至2023年11月10日在我院通过颈内静脉接受中心静脉导管（CVP）植入的80例成年患者。2023年7月18日前的前40例患者在超声（US）引导下采用传统针管进行颈内静脉穿刺（常规组）。此后，后40例患者使用3D针（3D针组）。存储并分析超声图像以计算变形率。
常规针的变形率为58.6%（13.2 - 100），3D针的变形率为41.8%（10.6 - 100）（P = 0.0034）。需要多次穿刺的患者，常规针组为2例，3D针组为12例（P = 0.0032）。所有患者及常规针组的变形率与穿刺前血管直径之间均呈弱负相关（分别为P = 0.24和0.41），3D针组无相关性。
3D针组颈内静脉壁的变形率低于常规针组。穿刺颈内静脉时使用3D针更安全。
