Introduction of ultrasound-guided axillary vein approach for central venous catheterization in severely injured trauma patients: characteristics and concerns.

BACKGROUND

The ultrasound-guided axillary vein approach for central venous catheterization (UAVC) demonstrates high success rates and low complications; however, its utilization in trauma care settings remains limited. This study aimed to characterize UAVC practices in a trauma intensive care unit (TICU) at a tertiary teaching hospital, specifically investigating optimal catheter positioning, procedure-related complications, and risk factors associated with catheter inaccurate placement and venous thromboembolism (VTE) development.

METHODS

A retrospective analysis was performed on trauma patients who underwent UAVC between October 2021 and April 2023. This analysis was based on electronic medical records. Details of patients, procedures, and instances of catheter misplacement were carefully documented. The immediate complications after UAVC, including pneumothorax, hemothorax, hematoma, arteriovenous fistula, arterial dissection, and skin infection, were recorded. Moreover, late-onset complications such as VTE and catheter-related bloodstream infections (CRBSI) were also noted. Logistic regression was utilized to determine the independent risk factors for non-optimal catheter tip placement and VTE.

RESULTS

A total of 132 UAVC cases were analyzed, with 113 (85.6%) performed by resident physicians and no immediate complications observed. The VTE incidence was 27.3%, particularly higher in elderly patients (≥ 65 years, 43.4%), and fever during TICU stay was noted in 55.3% of cases. Catheter-related infections occurred at a rate of 3.38 per 1,000 catheter days, with eight cases (6.06%) of catheter misplacement. Accurate placement was achieved in 29.8% of 121 patients, predominantly on the right side (40.4%). Factors influencing inaccurate placement included patient age [odds ratios (OR) 1.06, 95% confidence interval (CI) 1.02-1.10], obesity (OR 9.31, 95% CI 2.58-33.56), and left-side placement (OR 133.04, 95% CI 21.66-817.29), while patient age (>54 years), fever, and ventilation duration (>6.6 days) were associated with VTE development.

CONCLUSION

In severely injured trauma patients, UAVC is associated with a high incidence of VTE and a low rate of optimal catheter tip positioning. Our findings underscore the necessity of standardized protocols to refine catheter tip placement and warrant further investigation through randomized controlled trials.