Guidance and examination by ultrasound versus landmark and radiographic method for placement of subclavian central venous catheters: study protocol for a randomized controlled trial

Objectives-To compare ultrasound-guided right brachiocephalic vein (BCV) central venous catheter (CVC) placement to right subclavian vein (SCV) CVC insertion in terms of the puncture success rate and complications.Methods-A retrospective review was performed for all adult patients who received an ultrasound-guided CVC via the right BCV or right SCV access route between January 2016 and March 2018. The puncture success rates and procedure-related complications were analyzed.Results-Data were analyzed from 755 adult patients who underwent 915 CVC insertions. The overall success rate was higher in the BCV group compared to that in the SCV group (98.99% versus 96.87%; P = .019). The first-attempt success rate was higher in the BCV group compared to that in the SCV group (96.64% versus 89.34%; P < .001). Intraoperative complications were observed in 16 cases in the BCV group (2.68%) and in 12 cases in the SCV group (3.76%). The incidence rates of postprocedure complications were 5.20% in the BCV group and 6.58% in the SCV group and included catheter-related infections and thrombosis.Conclusions-Ultrasound-guided cannulation of the right BCV is an effective and safe method for CVC placement in adult patients and provides an additional option for catheter access.

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“…For SCV cannulation, a standard US‐guided in‐plane SCV CVC approach was used . Brightly, the US probe was place below the clavicle.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Ultrasound‐Guided Right Brachiocephalic and Right Subclavian Vein Cannulation in Adult Patients

Sun

Bai

Cheng

et al. 2019

J of Ultrasound Medicine

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“…These include lower cost, less delay, less radiation, no need to move patients, no need to break the sterile field, and greater accuracy. [1][2][3][4][5][6] We therefore explore the evidence base surrounding POCUS confirmation after upper extremity CVC insertion [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] because it is less well known than that supporting POCUS during insertion, and because it may be time to forego the post insertion CXR. 1,2,4,[22][23][24][25][26][27][28] There has also been comparatively little discussion regarding resistance to change and therefore this is reviewed too.…”

Section: Are Routine Chest Radiographs Still Indicated After Central ...mentioning

confidence: 99%

Are routine chest radiographs still indicated after central line insertion? A scoping review

Brindley,

Deschamps,

Milovanovic

et al. 2024

Journal of the Intensive Care Society

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Introduction: Central venous catheters are increasingly inserted using point-of-care ultrasound (POCUS) guidance. Following insertion, it is still common to request a confirmatory chest radiograph for subclavian and internal jugular lines, at least outside of the operating theater. This scoping review addresses: (i) the justification for routine post-insertion radiographs, (ii) whether it would better to use post-insertion POCUS instead, and (iii) the perceived barriers to change. Methods: We searched the electronic databases, Ovid MEDLINE (1946-) and Ovid EMBASE (1974-), using the MESH terms (“Echography” OR “Ultrasonography” OR “Ultrasound”) AND “Central Venous Catheter” up until February 2023. We also searched clinical practice guidelines, and targeted literature, including cited and citing articles. We included adults (⩾18 years) and English and French language publications. We included randomized control trials, prospective and retrospective cohort studies, systematic reviews, and surveys. Results: Four thousand seventy-one articles were screened, 117 full-text articles accessed, and 41 retained. Thirteen examined cardiac/vascular methods; 5 examined isolated contrast-enhanced ultrasonography; 7 examined isolated rapid atrial swirl sign; and 13 examined combined/integrated methods. In addition, three systematic reviews/meta-analyses and one survey addressed barriers to POCUS adoption. Discussion: We believe that the literature supports retiring the routine post-central line chest radiograph. This is not only because POCUS has made line insertion safer, but because POCUS performs at least as well, and is associated with less radiation, lower cost, time savings, and greater accuracy. There has been less written about perceived barriers to change, but the literature shows that these concerns- which include upfront costs, time-to-train, medicolegal concerns and habit- can be challenged and hence overcome.

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“…The complication rate with these techniques is in the range of 1-20% [9][10][11]. Although ultrasound-guided insertion may reduce the complication rate, the risk of complications is still substantial [9,12,13]. The transpulmonary lithium dilution technique involves an additional risk of lithium toxicity.…”

Section: Classification Of Co Monitoring Devices By Their Invasivenessmentioning

confidence: 99%

Perioperative Cardiac Output Monitoring Utilizing Non-pulse Contour Methods

Fujimoto

Suehiro

Mukai

et al. 2017

Curr Anesthesiol Rep

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Purpose of Review The purpose of this review was to provide an overview of the recent concepts regarding cardiac output measurement devices that utilize non-pulse contour methods, especially in an intraoperative setting. The techniques include inert gas rebreathing method, partial CO 2 rebreathing method, impedance cardiography, and its derivative technologies such as electrical velocimetry and bioreactance, transesophageal echocardiography/Doppler, and transthoracic echocardiography/Doppler. We focused on the invasiveness of the devices and their underlying technology. Recent Findings Although various types of cardiac output monitoring devices are available, none of them may be considered as an ideal device in terms of accuracy, trending ability of cardiac output changes, and reproducibility of measurements. There are increasing types of devices applicable for intraoperative use, yet only few data are available regarding the trending ability of cardiac output changes and reproducibility of the measurements. Therefore, the empirical application of these devices for various surgical patients may be done under the consideration of their invasiveness and their underlying technology, and it may provide us with more data over time.

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Guidance and examination by ultrasound versus landmark and radiographic method for placement of subclavian central venous catheters: study protocol for a randomized controlled trial

Cited by 3 publications

References 23 publications

Comparison of Ultrasound‐Guided Right Brachiocephalic and Right Subclavian Vein Cannulation in Adult Patients

Comparison of Ultrasound‐Guided Right Brachiocephalic and Right Subclavian Vein Cannulation in Adult Patients

Are routine chest radiographs still indicated after central line insertion? A scoping review

Perioperative Cardiac Output Monitoring Utilizing Non-pulse Contour Methods

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