Background: Ultrasound-guided axillary vein catheterization is now widely used in hospital, but it remains uncertain whether the distal axillary vein approach is more beneficial for seniors than the proximal axillary vein approach. This study aims to compare the puncture success rate and anatomical characteristics between these two approaches. Methods: Senior patients requiring central venous catheterization were enrolled and randomized to the proximal axillary vein group ( n = 49) or the distal axillary vein group ( n = 50). Proximal axillary vein and distal axillary vein location time, venous depth, maximum diameter, and collapse index (defined as the percentage change in vein width caused by respiration) were recorded for all patients. The rate of puncture success and operation time were compared between groups. Results: Mean venous depth was 1.93 ± 0.45 cm for proximal axillary vein and 1.79 ± 0.46 cm for distal axillary vein ( p < 0.001). Maximum diameter was 0.80 ± 0.33 cm for proximal axillary vein and 0.61 ± 0.33 cm for distal axillary vein ( p < 0.001). Collapse indices were 20% ± 27% and 56% ± 34%, respectively ( p < 0.001). Also, location time was significantly shorter for proximal axillary vein than for distal axillary vein ( p < 0.001). One attempt and overall success rates were significantly higher in the proximal axillary vein group, compared with the distal axillary vein group (71.4% vs 42.0%, p = 0.003; 79.6% vs 54.0%, p = 0.007). Conclusion: For catheterization under ultrasound guidance in elderly patients, the proximal axillary vein approach is superior to the distal axillary vein approach.

Background:The effect of different administration routes of omeprazole remains unclear on the recovery in patients with obesity after laparoscopic sleeve gastrectomy (LSG). Methods: We designed a randomized clinical trial enrolling 120 patients with a BMI≥32.5kg/m 2 after LSG. They were randomized into two groups to be administered with omeprazole by rapid intravenous injection (group A) or by continuous micropump infusion (group B). The plasma concentration of omeprazole was monitored upon initiating administration. Change in intragastric pH and gastrointestinal symptoms during follow-up served as indicators for therapeutic evaluation. Results: Patients in the two groups showed no difference in the AUC curves (P=0.25), but group A had significantly higher peak concentration (P<0.001), and shorter time to reach peak concentration after administration (P<0.001), compared to group B. Before and after the administration of omeprazole, the average change in intragastric pH was much lower in group A (0.031 ± 0.61) than in group B (0.48 ± 0.74) (P=0.004). The incidence of gastrointestinal symptoms was similar between the two groups (P=0.85); however, the average duration of remaining symptoms was longer in group A (3.97 months; 95% CI, 2.90-5.04) than in group B (2.82 months; 95% CI, 2.01-3.63) (P=0.04). Conclusion:Continuous micropump infusion of omeprazole may improve the outcomes in patients with obesity after LSG. Trial registration: China Clinical Trial Registration Center (ChiCTR), ChiCTR-IPR-17013365. Registered 13 November 2017. http://www.chictr.org.cn/showproj.aspx?proj=22892.