Thomsen Kristen K, Stekovic Jovana, Köster Felix, Bergholz Alina, Kouz Karim, Flick Moritz, Sessler Daniel I, Zöllner Christian, Saugel Bernd, Schulte-Uentrop Leonie
Department of Anaesthesiology, Center of Anaesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Outcomes Research Consortium, Houston, Texas, USA.
J Clin Monit Comput. 2024 Oct 14. doi: 10.1007/s10877-024-01232-4.
There are different techniques for ultrasound-guided central venous catheter (CVC) insertion. When using the conventional syringe-on-needle technique, the syringe needs to be removed from the needle after venous puncture to pass the guidewire through the needle into the vein. When, alternatively, using the wire-in-needle technique, the needle is preloaded with the guidewire, and the guidewire-after venous puncture-is advanced into the vein under real-time ultrasound guidance. We tested the hypothesis that the wire-in-needle technique reduces the time to successful guidewire insertion in the internal jugular vein compared with the syringe-on-needle technique in adults.
We randomized 250 patients to the wire-in-needle or syringe-on-needle technique. Our primary endpoint was the time to successful guidewire insertion in the internal jugular vein.
Two hundred and thirty eight patients were analyzed. The median (25th percentile, 75th percentile) time to successful guidewire insertion was 22 (16, 38) s in patients assigned to the wire-in-needle technique and 25 (19, 34) s in patients assigned to the syringe-on-needle technique (estimated location shift: 2 s; 95%-confidence-interval: - 1 to 5 s, p = 0.165). CVC insertion was successful on the first attempt in 103/116 patients (89%) assigned to the wire-in-needle technique and in 113/122 patients (93%) assigned to the syringe-on-needle technique. CVC insertion-related complications occurred in 8/116 patients (7%) assigned to the wire-in-needle technique and 19/122 patients (16%) assigned to the syringe-on-needle technique.
The wire-in-needle technique-compared with the syringe-on-needle technique-did not reduce the time to successful guidewire insertion in the internal jugular vein. Clinicians can consider either technique for ultrasound-guided CVC insertion in adults.
超声引导下中心静脉导管（CVC）置入有不同的技术。使用传统的针筒技术时，静脉穿刺后需要将针筒从针上取下，以便将导丝通过针送入静脉。另一种方法是使用针内导丝技术，针预先装有导丝，静脉穿刺后，在实时超声引导下将导丝推进静脉。我们检验了这样一个假设：与成人的针筒技术相比，针内导丝技术能减少颈内静脉成功置入导丝的时间。
我们将250例患者随机分为针内导丝技术组或针筒技术组。我们的主要终点是颈内静脉成功置入导丝的时间。
对238例患者进行了分析。分配到针内导丝技术组的患者成功置入导丝的中位时间（第25百分位数，第75百分位数）为22（16，38）秒，分配到针筒技术组的患者为25（19，34）秒（估计位置偏移：2秒；95%置信区间：-1至5秒，p = 0.165）。分配到针内导丝技术组的103/116例患者（89%）和分配到针筒技术组的113/122例患者（93%）首次尝试CVC置入即成功。分配到针内导丝技术组的8/116例患者（7%）和分配到针筒技术组的19/122例患者（16%）发生了与CVC置入相关的并发症。
与针筒技术相比，针内导丝技术并未减少颈内静脉成功置入导丝的时间。临床医生在成人超声引导下CVC置入时可考虑任一种技术。
