Abstract
Introduction: Central venous catheterization (CVC) is being done all over the world. It has specific indications and should be reserved for the patient who has the potential to benefit from it. Catheter related infections are an important cause of morbidity and mortality worldwide. All complications and side effects are dependent on vascular access route. International data shows malpositioning and pneumothorax related to malpositioning to be the most common complications of central venous cannulation. However there is paucity of local data regarding which of the two, IJV or SCV routes are more prone to develop these complications. Aims & Objectives: To compare the incidence of pneumothorax and malpositioning with internal jugular vein (IJV) and subclavian vein (SCV) routes of central venous catheters. Place and duration of study: This randomized control trial was conducted at Department of Anesthesia, Shaikh Zayed Hospital, Lahore, from 8-12-2014 to 7-6-2015. Material & Methods: The non-probability purposive sampling technique was used in this study. After the approval of Hospital Ethical Committee, 290 patients were included in this study and informed consent was obtained. Demographic profile was also obtained. Patients were randomly divided in two groups by using lottery method. In Group A, CVC was inserted through internal jugular vein while in Group B, CVC was inserted through subclavian vein. During the procedure, malpositioning and pneumothorax were monitored immediately and after 36 hours and were labeled. Patients were shifted to the ward after procedure and were followed-up there. During first 36 hours, chest x-ray for placement of tip of catheter and development of pneumothorax was carried out. Chi-square was used to compare complications in both groups taking p value <0.05 as significant. Results: Malposition was found in 18 cases, (6 from IJV group and 12 from SCV group) (p-value 0.144). Pneumothorax was seen in 12 cases (3 from IJV and 9 from SCV group) (p-value 0.077). Conclusion: Our study results concluded that IJV showed fewer incidences of pneumothorax and malpositioning than SCV technique. However, the difference was not statistically significant.
Highlights
Central venous catheterization (CVC) is being done all over the world
Malposition was found in 18 cases in which 6 patients were from internal jugular vein (IJV) group and 12 were from subclavian vein (SCV) group, malposition was not found in 272 cases in which 139 were from IJV group and 133 were from SCV group
Pneumothorax was observed in 12 cases, in which 3 patients were from IJV group and 9 were from SCV group, pneumothorax was not observed in 278 cases in which 142 were from IJV group and 136 were from SCV group
Summary
Central venous catheterization (CVC) is being done all over the world. It has specific indications and should be reserved for the patient who has the potential to benefit from it. Varying with the number of Chances of Pneumothorax and Malpositioning of Central Venous Catheters in Internal Jugular Vein attempts in emergent conditions where large catheters like dialysis catheters are inserted.[4] Overall complication rates range upto 15%, mechanical complications reported in 19% of patients, 26% infectious complications, and 26% thrombotic complications.[5] It is seen that incidence of pneumothorax varies in different studies.[6] Luyt et al, conducted a randomized trial and reported that the incidence of malposition was reported to be low with IJV (1.8%) as compared to SCV (7.4%), the difference was insignificant (p=0.07) and the incidence of pneumothorax was nil (0) with IJV as compared to SCV (3.2%), (p=0.09).[7] Due to the presence of conflicting international data and scarcity of our own, the research was designed to determine these complications in relation to IJV & SCV routes in our local setting
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