Short-axis/out-of-plane versus long-axis/in-plane ultrasound-guided central venous catheter placement by inexperienced trainees

Abstract

Background Ultrasound (US) guidance for central venous catheter (CVC) placement is considered gold standard in localization and cannulation, making the procedure safer with less complications. Objective To compare the short-axis/out-of-plane (SAX) with the long-axis/in-plane (LAX) technique for US-guided CVC insertion in internal jugular vein in intensive care practice regarding safety and efficacy. Patients and methods A prospective randomized trial was conducted in Zagazig University Hospitals, from October 2017 to October 2018. All were randomized into one of two groups according to US guidance technique: SAX technique (group S), including 116 patients, and the LAX technique (group L), including 116 patients, for US-guided CVC insertion in internal jugular vein. The primary outcome was first-attempt success rate of both the SAX and LAX approaches for US-guided vascular catheterization. The secondary outcomes were total success rate, which was defined as successful venous cannulation without complication; cannulation times calculated in seconds; the number of attempts; and complications (hematoma and arterial puncture). Results US-guided venous cannulation was successful without complications in 115 (99.14%) patients. Venous access time, catheterization time, and US imaging time were significantly lower in the group S than in the group L (P<0.05). Complications in both groups had no significant difference. Hematoma formation was evident in one patient in group L. Multiple puncture was more in LAX group, with no significant difference.