Incidence Of Arterial Puncture Research Articles

Ease of Internal Jugular Venous Cannulation by Anterior V/S Posterior Approach: A Randomized Interventional Study

Background: Percutaneous cervical central venous cannulation is now common practice during Perioperative care in major surgical procedures, critically ill patients in intensive care units for long term hyperalimentation and for rapid restoration of blood volume in cases of acute blood loss. Proper route of insertion is essential for its success. The objective of this study is to compare procedural parameters and complications associated with anterior and posterior approaches for Internal Jugular Venous cannulation.
 Methods: Our study was conducted as a prospective randomized interventional trail in 60 patients undergoing scheduled cardiac surgeries requiring Right internal jugular venous cannulation in a tertiary level hospital after obtaining clearance from ethics committee, patients were randomly allocated into two groups either Anterior approach (Group A; n=30) or Posterior Approach (Group B; n=30). Number of attempts, time for identification of IJV, duration of cannulation, ease of insertion, complications were compared in both the groups.
 Results: The number of attempts (p value 0.036), mean time taken for vein identification (p value 0.0003), catheterization time (p value <0.001), incidence of arterial puncture and hematoma are less with posterior approach, ease of threading is comparable among both the group. There were no statistically significant intergroup differences with respect to the Age, Sex, ASA grade.
 Conclusion: The posterior approach is better than anterior approach for Internal Jugular Vein Cannulation, as it improves the success rate, permits easy threading of catheter, reduces access time and duration of cannulation, complications like arterial puncture, hematoma, pneumothorax are lesser in posterior approach.

ULTRASOUND GUIDED CENTRAL VENOUS CANNULATION BY ANESTHESIA TRAINEE: NEED OF THE HOUR DURING COVID PANDEMIC

Covid pandemic has created deciency of doctors needed to administer skilled procedures in ICUs and operating rooms. Post graduate trainees need to acquire skills fast and perform it safely on patients. Ultrasound (USG)-guided central venous cannulation (CVC) is one such. The study aimed at nding the feasibility of training USG-guided CVC cannulation to anesthesia trainee as opposed to landmark method in terms of ease, speed and safety. Patients needing CVC were divided into 2 groups of 50 each, where Group 1 was subjected to Landmark method and Group 2 to USG-guided method. Continuous variables were compared using unpaired t test and categorical variables using either the Chi square test. Access time (in seconds) was signicantly less in the USG group (258.78 ± 11.17) as opposed to Landmark technique (301.60 ± 14.03) (p 0.03). Accidental carotid artery puncture was seen in 9 patients in Landmark group as opposed to none in the USG group. No patient in any group developed pneumothorax. USG-guided technique is superior and safer than the traditional landmark technique in hands of anaesthesia trainee in terms of a shorter access time, and less incidence of arterial puncture which is desirable in COVID patients to shorten the exposure time. USG-guided method needs an assistant to focus the probe. Nonetheless, this training should be imparted to the trainee to ll the gap created by skilled doctors falling sick during COVID pandemic.

Safety and efficacy of the oblique-axis plane in ultrasound-guided internal jugular vein puncture: A meta-analysis.

ObjectiveThis meta-analysis was performed to evaluate the safety and efficacy of the oblique-axis plane in ultrasound-guided internal jugular vein puncture.MethodsWe searched Embase, PubMed, the Cochrane Library, Web of Science, and China National Knowledge Infrastructure for relevant randomized clinical trials comparing the oblique axis with the short axis in ultrasound-guided internal jugular vein puncture.ResultsFive randomized clinical trials were included in this meta-analysis. The pooled meta-analysis showed that the incidence of arterial puncture in the oblique-axis group was significantly lower than that in the short-axis group. No significant difference was found in the first-pass success rate between the oblique-axis group and short-axis group. Additionally, there were no significant differences in the puncture success rate or number of attempts required between the two groups.ConclusionUltrasound-guided internal jugular vein puncture using the oblique-axis plane reduced the risk of arterial puncture, but no difference was found in the first-pass success rate, puncture success rate, or number of attempts required.

Incidence of posterior wall penetration during internal jugular vein cannulation: A comparison of two techniques using real-time ultrasound.

Background and Aims:The true incidence of penetration of the posterior wall (through-and-through puncture) of the internal jugular vein (IJV) during cannulation is unknown. This may have implications if there is hematoma formation, penetration and/or inadvertent cannulation of an underlying carotid artery. This study compared the incidence of posterior wall puncture during IJV cannulation using ultrasound guidance versus traditional landmarks-guided technique.Methods:One hundred and seventy adult patients admitted to a gastro-liver Intensive Care Unit who required central venous lines were randomly divided into Group A: IJV cannulation using anatomical landmark-guided technique and Group B: IJV cannulation using real-time ultrasound guidance. In both groups, a second investigator followed the needle path using real-time ultrasound. The incidence of posterior wall puncture, number of attempts for successful cannulation, incidence of inadvertent arterial punctures and occurrence of complications such as hematoma formation and pneumothorax were recorded.Results:Significantly more (37/80, 46%) patients in Group A had posterior wall puncture compared to 19/90 (21%) in Group B. Incidence of arterial puncture was 8/80 (10%) in Group A, 5/90 (5.5%) in Group B. The number of attempts for venous cannulation and hematoma formation was significantly less in Group B.Conclusion:Real-time ultrasound-guided IJV cannulation significantly reduces but does not wholly eliminate the incidence of posterior venous wall penetrations. It also significantly reduces the incidence of inadvertent arterial punctures and number of attempts for successful cannulation.

Accidental arterial puncture during right internal jugular vein cannulation in cardiac surgical patients.

Background:The primary aim of this study was to compare the incidence of accidental arterial puncture during right internal jugular vein (RIJV) cannulation with and without ultrasound guidance (USG). The secondary end points were to assess if USG improves the chances of successful first pass cannulation and if BMI has an impact on incidence of arterial puncture and the number of attempts that are to be made for successful cannulation.Settings and Design:Prospective observational study performed at a single tertiary cardiac care center. Material and methods: 255 consecutive adult and pediatric cardiac surgical patients were included. In Group I (n = 124) USG was used for the right internal jugular vein cannulation and in Group II (n = 81) it was not used. There were 135 adult patients and 70 pediatric patients. Statistical analysis: Demographic and categorical data were analyzed using Student ‘t’ test and chi- square test was used for qualitative variables.Results:The overall incidence of accidental arterial puncture in the entire study population was significantly higher when ultrasound guidance was not used (P < 0.001). In subgroup analysis, incidence of arterial puncture was significant in both adult (P = 0.03) and pediatric patients (P < 0.001) without USG. First attempt cannulation was more often possible in pediatric patients under USG (P = 0.03). In adult patients USG did not improve first attempt cannulation except in underweight patients.Conclusions:USG helped in the avoidance of inadvertent arterial puncture during RIJV cannulation and simultaneously improved the chances of first attempt cannulation in pediatric and in underweight adult cardiac surgical patients.

Comparison of the landmark technique and the static ultrasound-guided technique for internal jugular vein cannulation in adult cardiac surgical patients

Background: The use of real time ultrasound (US) for insertion of central venous catheters is limited by various factors such as availability, space constraints, and perceived lack of need according to surveys including cardiovascular anesthesiologists. Methods: After the ethical committee approval and patient consent, 201 adult patients scheduled for elective cardiac surgery were randomized to undergo internal jugular vein (IJV) cannulation by either of the two methods: Landmark technique (control group), static US technique using the transthoracic echocardiography (TTE) probe (US group). The success rate, number of attempts, total cannulation time, and complication rate in the two groups were compared. Results: The overall success rate and the first attempt success rate were significantly higher in the control group than the US group (99% vs. 89.6%, P = 0.003 and 87.6% vs. 70.8%, P = 0.003, respectively). The total number of attempts to locate the IJV with the finder needle as well as the puncture needle was significantly lower in the control group than the US group (2.2 vs. 1.3, P = 0.001and 1.7 vs. 1.2, P = 0.021, respectively). The incidence of arterial puncture was higher in the US group than the control group (9.4% vs. 1.9%, P= 0.020). The total cannulation time was also higher in the US group (430 ± 320 s) than the control group (197 ± 116 s, P= 0.001). Conclusion: The landmark technique has a higher success rate, lower complication rate, and total cannulation time as compared with the static US technique using the TTE probe for IJV cannulation in adult cardiac surgical patients.

English

Introduction Ultrasound guidance for cannulation of the internal jugular vein has been shown to improve success and complication rates in comparison with the landmark techniques. The aim of this study is to verify if ultrasound is also cost-effective. Materials and Methods A systematic review of the literature in PubMed, Medline, and Google was performed between years 1966 and 2010. A decision tree model was built with failure and complication rates from the studies selected. A costeffectiveness analysis and sensitivity analysis were performed with this model. Randomised controlled trials on adult patients, with real-time B-mode ultrasound guidance, comparison between ultrasonography and landmark methods and reported outcomes (early complications, failures, time to successful cannulation) were included. Exclusion criteria were: enrolment of paediatric patients, ultrasound before puncture, Doppler ultrasound guidance, no clear description of outcomes, and no prospective clinical trial. Results About 8 randomised controlled trials were selected. The ultrasound guidance significantly reduces the occurrence of arterial puncture (risk ratio, risk ratio 0.21, 95% CI 0.13–0.33), pneumothorax complications (risk ratio 0.15, 95% CI 0.03–0.88), and cannulation failures (R 0.12, 95% CI 0.04-0.39). It proves to have € 1,225 additional cost every 1,000 procedures. The major determinants of ultrasound costs are the purchase cost of the ultrasound unit and the machine uses per week. Conclusion Although the ultrasound approach introduces a clinically relevant improvement of success and complication rates, it does not appear to be cost-effective. Introduction Central venous catheters (CVCs) are essential for the clinical management of many patients both in the acute care setting and in the chronic, longterm care. Studies have reported an associated complication rate >15% for central venous cannulations1,2. Up to recent years, the internal jugular vein (IJV) has gained the greatest popularity among the different central cannulation routes due to its consistent anatomical position, large diameter, and low likelihood of catheter obstruction or misplacement3. This route, however, is not devoid of early mechanical complications like arterial puncture and pneumothorax. Two meta-analyses have shown that ultrasound-guided CVC placement is associated with a significant improvement of early complication rates, length of execution, and firstpass success rate when compared with the landmark (LM) technique4,5. However, in a survey by the Society of Cardiovascular Anaesthesiologists only 15% of responders stated to routinely use ultrasound (US) for CVC placement6. A presumed higher procedural cost was among the most common objections for not utilizing this approach. According to many providers, the initial financial investments for equipment and operators’ training, and fixed costs for maintenance and additional supplies (e.g. sterile sheaths), may not be outweighed by the better clinical performances of US guidance. Calvert and coworkers have performed a decision analysis showing that B-mode US guidance for CVC placement is significantly cost-effective when compared with the traditional LM technique7,8. Their decision model considered a 12% incidence of arterial puncture and a 9% failure for internal jugular vein cannulations with the LM technique. Although the analysis used conservative assumptions against the US approach (such as no pneumothorax complications, expert operators, allowance of only one failed attempt), these complication rates are higher than data published in the studies on CVC placement with the LM approach9,10. The aim of this study is to perform a systematic review of the existing literature and to update the economic evaluation of cost-effectiveness of real-time B-mode US guidance compared with the LM technique for IJV cannulation. Materials and Methods Selection of studies A search in PubMed, Medline, and Google was carried out with the following headings: central venous catheter, internal jugular vein, and ultrasound. Articles were limited to those in English. The time period was between 1966 and December 2010. Inclusion criteria were: * Corresponding author Email: riccardo.moretti77@gmail.com 1 Teaching Hospital of Val Vibrata, Department of Anesthesia and Critical Care, Sant’Omero (Teramo) Italy 2 Department of Cost Analysis and Control, HBG, Rome, Italy

Ultrasonic Guided Insertion of Central Venous Catheter in Infants and Children

Background/Purpose: ultrasound is licensed for application of regional blocks and insertion of vascular access. We aimed to compare ultrasonic guided (USG) and anatomical landmark technique (ALT) for insertion of central venous catheter (CVC) as regard success rate and rate of complications in infants and children. Materials & Methods: eighty childen (age ranged from 1-5 y) were classified into 2 groups, anatomical landmark technique was used to insert CVC in group I and ultrasonic guided technique was used in group II. Number of trials, duration of the procedure, and rate of complications were recorded. Results: There was a significant increase in success rate of insertion in group II as compared to group I (p = 0.001). Number of trials showed significant decrease in group II as compared to group I (p<0.0001). Incidence of arterial puncture was significantly decreased in group II (p = 0.028). Duration of the procedure was 21.3 ± 0.05 min in group I, and 12.5 ± 0.3 min in group II, ( p<0.0001). Conclusion: Insertion of central venous catheter in children should be guided with ultrasonography to avoid complications and failure of the procedure. Index Word: CV line insertion, ultrasonography.

An outcome study on complications using routine ultrasound assistance for internal jugular vein cannulation

Ultrasound guidance for central venous cannulation is advised by recent guidelines, but is not being applied in everyday practice. The purpose of this study was to determine the reduction in complications when applying an ultrasound locating device for internal jugular vein catheterization. An observational study was conducted from November 2004 to October 2005 in a tertiary neurosurgical hospital on 300 patients undergoing internal jugular vein cannulation using an ultrasound technique. Patients were not randomized and operators were trained using theoretical and practical courses. Prior to the study, the investigators, who were consultant anaesthesiologists, had to perform at least 20 successful supervised cannulations. Cannulation was successful in all cases. The incidence of arterial puncture was 2.7%, and multiple venous punctures represented the main minor complication (14%). Bivariate analysis of the overall complications revealed no significant correlation with age group, American Society of Anesthesiologists' (ASA) classification, body mass index, or position and diameter of the vein. Ultrasound cannulation of the internal jugular vein minimized complications. These could be avoided when new ultrasound probes and specific needles are introduced.

A randomized‐controlled study of ultrasound prelocation vs anatomical landmark‐guided cannulation of the internal jugular vein in infants and children

A specifically designed ultrasound scanner may be helpful in percutaneous cannulation of the internal jugular vein in pediatric patients. We report a new two-dimensional (2D) ultrasound prelocation (UL) technique using a transesophageal echocardiography (TEE) intraoperative probe instead of the portable scanner, and have compared the new technique with conventional anatomical landmark method (AL) for central venous catheterization in infants and children. Sixty-two infants (body weight <12 kg) undergoing elective surgery for congenital heart disease were randomized into two groups. In the AL group, the landmark for cannulation was the palpation of the common carotid pulsation or the sternocleidomastoid triangle. In the UL group, the central vein was located by 2D ultrasonic imaging using a TEE intraoperative probe for HP SONOS 4500. The number of cannulation attempts, success rate, and complication rate were recorded. For the UL and AL groups, the cannulation success rate was 100% and 80% (P < 0.05), the incidence of arterial puncture was 3.1% and 26.7% (P < 0.025), and the number of attempts was 1.57 +/- 1.04 and 2.55 +/- 1.76 (P < 0.001), respectively. Two-dimensional ultrasound prelocated central venous catheterization in infants and children is convenient and can markedly increase cannulation success rate and reduce the incidence of complications.

Does ultrasound imaging before puncture facilitate internal jugular vein cannulation? Prospective randomized comparison with landmark-guided puncture in ventilated patients

Objective: To investigate whether prepuncture ultrasound evaluation of vascular anatomy facilitates internal jugular vein cannulation compared with landmark-guided puncture. Design: Prospective randomized study. Setting: Single community hospital. Participants: Adult patients undergoing general anesthesia (n = 240). Interventions: The right internal jugular vein was cannulated using either anatomic landmarks or prepuncture ultrasound (3.75/7.5 MHz) guidance. In the landmark group, respiratory jugular venodilation was used as the primary landmark for locating the vein. Results of cannulation and the incidence of complications were compared. Measurements and Main Results: Patients were randomly assigned to the ultrasound or landmark group. Respiratory jugular venodilation was identified in 188 patients (78.3%), in whom results of cannulation did not differ between the 2 techniques with respect to the venous access rate (cannulated at the first attempt: 83.5% in the landmark v 85.7% in the ultrasound group), the success rate (cannulated within 3 attempts: 96.9% v 95.6%), and the incidence of arterial puncture (1.0% v 3.3%). In the remaining 52 respiratory jugular venodilation–unidentified patients, the access rate (30.4% v 86.2%, p < 0.001) and the success rate (78.3 v 100%, p < 0.05) were significantly better in the ultrasound group, and no arterial puncture was recorded in the ultrasound group, whereas the incidence was 13.0% in the landmark group. The results were similar regardless of the ultrasound frequency used. Conclusion: Prepuncture ultrasound evaluation did not improve the result of right internal jugular vein cannulation compared with the respiratory jugular venodilation–guided approach. When the landmark was not observed, however, the prepuncture ultrasound guidance was helpful in facilitating the cannulation. Copyright 2002, Elsevier Science (USA). All rights reserved.

Respiratory jugular venodilation: A new landmark for right internal jugular vein puncture in ventilated patients

Objective: To report a new technique for right internal jugular vein puncture using respiratory jugular venodilation as a landmark for vein location. Design: Prospective observational study. Setting: Single community hospital. Participants: Two hundred patients undergoing right internal jugular vein cannulation under general anesthesia. Interventions: Catheter placement was attempted using respiratory jugular venodilation as the primary landmark. When it was not applicable, an alternative technique using the carotid pulse as a landmark was used. Measurements and Main Results: Visibility of the venodilation, the number of needle passes, the success rate, and the incidence of arterial puncture were analyzed. Respiratory jugular venodilation was observed in 158 patients (79%). In this group of patients, the jugular vein was cannulated at the first attempt in 83.5% of patients, and arterial puncture occurred in one patient (0.6%). In the remaining 42 patients (21%) lacking the visible venodilation, catheter placement was accomplished at the first attempt in 42.9% of patients ( p < 0.01 v the venodilation-visible group), and 4 patients (9.5%) suffered arterial puncture ( p < 0.01). The overall incidence of arterial puncture was 2.5%. The success rate of cannulation (within four needle passes and no arterial puncture) was 98.1% in the venodilation-visible patients and 73.8% in the others ( p < 0.01), with the overall success rate of 93%. Conclusions: Respiratory jugular venodilation can be identified in a large proportion of ventilated patients. This experience suggests that respiratory jugular venodilation could be favorably used as the primary landmark for right internal jugular vein puncture in anesthetized patients.

The incidence of artery puncture with central venous cannulation using a modified technique for detection and prevention of arterial cannulation

Background: Cannulation of the central circulation is essential for management of patients who require major surgery, and for patients who are critically ill. Arterial puncture is the most frequent complication associated with central venous cannulation, and is potentially fatal. Detection of arterial puncture can be problematic, especially in patients with cyanotic congenital heart disease. Methods: One thousand eleven consecutive cardiothoracic and vascular surgical patients who required central venous cannulation were studied using a new technique for detection of arterial puncture and prevention of arterial cannulation. This technique involves continuous pressure transduction of the steel introducer needle. Central venous cannulation was attempted in all patients. The sites of attempted catheterizations, number of arterial punctures and cannulations, and the number of successful catheterizations were noted. All patients were treated in accordance with standard anesthetic and surgical techniques in the institution. Results: One thousand one hundred seventy-two central venous catheters were placed. The overall success rate was 99.6%. The incidence of arterial puncture was 9.3% for central venous cannulation attempts of the internal jugular, subclavian, and femoral veins. No arterial cannulation occurred, and none of the patients had significant complications. Congenital heart disease patients had a higher incidence of arterial puncture (14.1%) and a lower rate (96.8%) of successful cannulation. Conclusion: Pressure transduction of the steel needle is a useful technique for detecting arterial puncture and preventing arterial cannulation during attempts to achieve central venous cannulation.

Cathétérisme de l'artère pulmonaire par abord percutané de la veine axillaire

The choice of venous access can be difficult in patients under intensive care. The axillary vein appeared interesting to evaluate. This prospective study involved 63 punctures carried out in 59 patients during a 16 month period (14 females and 45 males; mean age : 54±4 yr). 34 patients were tracheostomized and under controlled respiration; some had coagulation abnormalities (8 cases). The other 29 patients were undergoing a preoperative haemodynamic study. Puncture of the axillary vein was carried out with the needle inserted at an angle of 30° to the skin surface and directed parallel to the artery medial to its course. The Seldinger technique was used (catheter and guide wire). Overall success rate was 87.5 %. In 73 %, less than three attempts were required. After the catheter was set in place in the axillary vein, the mean time required to reach the pulmonary artery was 7±15 min (range : 20 s-45 min). Less than 1 min was needed in 60 %. Extrasystoles were observed in 3.6 %. The incidence of arterial puncture was 11 % without any late complications. In every case, pulmonary artery and capillary wedge pressure curves were obtained, as well as cardiac output measurements. Mean duration of catheterization was 2±1.1 days in the preoperative haemodynamic group and 4±1.7 days in the other. No infectious complication was related to the catheterization. One thrombosis of the axillary and suclavian veins was noted (1.8 %). The axillary vein appeared therefore to be useful for pulmonary artery catheterization. It is an alternative choice in patients under controlled ventilation and with coagulation problems.