Document Type : Research articles

Authors

Department of Intensive Care, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences, Ankara, Turkey

Abstract

Background: Central venous catheterization (CVC) insertion is a common invasive procedure performed in critical care patients. Although this procedure is considered to providebetter patient comfort and a lower risk of infection compared to other methods, it has a higher risk of complications such as pneumothorax, arterial puncture, nerve injury, and bleeding. Ultrasonography (USG)-guided subclavian catheterization hasrecently become a popular technique. In this study, we retrospectively analyzed 50 patients who underwent infraclavicular subclavian catheterization with the out-of-plane technique under USG guidance.
Materials and Methods: The retrospective study included50 patients who underwent subclavian CVC insertion via the out-of-plane technique under USG guidance in our intensive care unit (ICU)between March and December 2020.
Results: The 50 patients comprised 27 (54%) men and 23 (46%) women with a mean age of 72.8±11.8 years. In all patients, subclavian CVC insertion was successfully performed under USG guidance via the out-of-plane technique. Mean procedural time was 220.90±60.20 sec. Only one complication (pneumothorax) developed in one patient, who underwent tube thoracostomy. The procedure was completed in a single session in 27 (54%), two sessions in 22 (44%), and three sessions in 1 (2%) patient. No catheter malposition was observed in any patient.
Conclusion: USG-guided subclavian catheterization isa safetechnique to be performed by experienced practitioners.

Keywords

  1. Bodenham Chair A, Babu S, Bennett J, Binks R, Fee P, Fox B, et al. Association of anaesthetists of great Britain and Ireland: Safe vascular access 2016. Anaesthesia. 2016;71(5):573–585. doi: 10.1111/anae.13360. [PubMed: 26888253].
  2. Frykholm P, Pikwer A, Hammarskjöld F, Larsson AT, Lindgren S, Lindwall R, et al. Clinical guidelines on central venous catheterisation. Acta Anaesthesiol Scand. 2014;58(5): 508–24. doi:10.1111/aas.12295.
  3. Eisen LA, Narasimha M, Berger JS, Mayo PH, Rosen MJ. Mechanical complications of central venous catheters.
  4. J Intensive Care Med. 2006;21(1):40-6. doi: 10.1177/0885066605280884. [PubMed: 16698743].
  5. Parienti JJ, du Cheyron D, Timsit JF, Traore O, Kalfon P, Mimoz O, et al. Meta-analysis of subclavian insertion and nontunneled central venous catheter-associated infection risk reduction in critically ill adults. Crit Care Med. 2012;40(5):1627-34. doi: 10.1097/CCM.0b013e31823e99cb. [PubMed: 22511140].
  6. Schulman PM, Gerstein NS, Merkel MJ, Braner DA, Tegtmeyer K. Ultrasound-guided cannulation of the subclavian vein. N Engl J Med. 2018;379(1):1. doi: 10.1056/NEJMvcm1406114. [PubMed: 29972747].
  7. Brass, P, Hellmich, M, Kolodziej, L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database Syst Rev. 2015;1(1):1-73.doi: 10.1002/14651858.CD011447. [PubMed: 25575245].
  8. Lanspa MJ, Fair J, Hirshberg EL, Grissom CK, Brown SM. Ultrasound-guided subclavian vein cannulation using a micro-convex ultrasound probe. Ann Am Thorac Soc. 2014;11(4):
  9. -6. doi: 10.1513/AnnalsATS.201311-414BC. [PubMed: 24611628].
  10. Lalu MM, Fayad A, Ahmed O, Bryson GL, Fergusson DA, Barron CC, et al. Ultrasound-guided subclavian vein catheterization: a systematic review and meta-analysis. Crit Care Med. 2015;43(7):1498-507. doi: 10.1097/CCM.0000000000000973. [PubMed: 25803646].
  11. Davies TW, Montgomery H, Gilbert-Kawai E. Cannulation
  12. of the subclavian vein using realtime ultrasound
  13. guidance. J Intensive Care Soc. 2020;21(4):349-54. doi: 10.1177/1751143720901403. [PubMed: 34093738].
  14. Fragou M, Gravvanis A, Dimitriou V, et al. Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: a prospective randomized study. Critical Care Medicine. 2011;39(7):1607-12. doi: 10.1097/CCM.0b013e318218a1ae. [PubMed: 21494105].
  15. Saugel B, Scheeren TWL, Teboul JL. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care. 2017;21(1):1-11. doi: 10.1186/s13054-017-1814-y. [PubMed: 28844205].
  16. Tsotsolis N, Tsirgogianni K, Kioumis I, Pitsiou G, Baka S, Papaiwannou A, et al. Pneumothorax as a complication of central venous catheter insertion. Ann Transl Med. 2015;3(3):1-10. doi: 10.3978/j.issn.2305-5839.2015.02.11. [PubMed: 25815301].
  17. Kusminsky RE. Complications of central venous catheterization. J Am Coll Surg. 2007;204(4):681-96. doi: 10.1016/j.jamcollsurg.2007.01.039. [PubMed: 17382229].
  18. Troianos CA, Hartman GS, Glas KE, Skubas NJ, Eberhardt RT, Walker JD, et al. Councils on intraoperative echocardiography and vascular ultrasound of the American society of echocardiography. guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of echocardiography and the society of cardiovascular anesthesiologists. J Am Soc Echocardiogr. 2011;24(12):1291-318. doi: 10.1016/j.echo.2011.09.021. [PubMed: 22115322].
  19. Tammam TF, El-Shafey EM, Tammam HF. Ultrasound-guided internal jugular vein access: comparison between short axis and long axis techniques. Saudi J Kidney Dis Transpl. 2013;24(4):707-13. doi: 10.4103/1319-2442.113861. [PubMed: 23816718].
  20. Bouaziz H, Zetlaoui PJ, Pierre S, Desruennes E, Fritsch N, Jochum D, et al. Guidelines on the use of ultrasound guidancefor vascular access. Anaesth Crit Care Pain Med. 2015;34(1):65-9. doi: 10.1016/j.accpm.2015.01.004. [PubMed: 25829319].
  21. . Palepu GB, Deven J, Subrahmanyam M, Mohan S. Impact of ultrasonography on centralvenous catheter insertion in intensive care. Indian J Radiol Imaging. 2009;19(3):191-8. doi: 10.4103/0971-3026.54877.
  22. Liu C, Mao Z, Kang HJ, Hu X, Jiang S, Hu P, et al. Comparison between the long-axis/in-plane and short-axis/out-of-plane approaches for ultrasound-guided vascular catheterization: an updated meta-analysis and trial sequential analysis. Ther Clin Risk Manag. 2018;14:331-340. doi: 10.2147/TCRM.S152908. [PubMed: 29503552].