Static Ultrasound Guidance VS. Anatomical Landmarks for Subclavian Vein Puncture in the Intensive Care Unit: A Pilot Randomized Controlled Study

Wang, Qingyu; Cai, Jiming; Lü, Zhiwei; Zhao, Qiu; Yang, Yufang; Sun, Li; He, Qun; Xu, Shaofa

doi:10.1016/j.jemermed.2020.07.039

Cited by 2 publications

(5 citation statements)

References 37 publications

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“…The inclusion of the RCTs of Mansfield et al (14) and/or Wang et al (20) and/or prospective study conducted by Sidoti et al (15) in the sensitivity analyses did not change the results. The “leave-one-out” sensitivity analysis affected only one result in the secondary outcomes (access time), where the exclusion of the study by Singam et al (33) resulted in a p value shift from 0.006 to 0.09.…”

Section: Resultsmentioning

confidence: 99%

“…After screening, 14 fulltext articles were assessed against PICOS criteria and three were excluded: two for language restriction (n = 1 Japanese, n = 1 French [29,30]) and one for being a duplicate. Five studies were included in the sensitivity analysis: two RCTs based on static ultrasound guidance (14,20), one prospective study [15]), and two retrospective studies (31,32). The remaining six RCTs (13,(16)(17)(18)(19)21) were included in the quantitative analysis; their characteristics are reported in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The majority of the included studies recruited ICU patients (13,(17)(18)(19)21), although only one study by Fragou et al (18) specified that all patients were mechanically ventilated during cannulation. Three studies provided description of the operator's level of experience in ultrasound-guided SCV cannulation (16,20,21), which was highly variable. Three studies assessed real-time long-axis (in plane) ultrasound-guided cannulation (16,18,21); the remainder consisted of shortaxis (out of plane) cannulation (13,17,19).…”

Section: Resultsmentioning

confidence: 99%

“…Two further independent searches were performed manually by two authors (M.Z., L.L.V. ), which included a review of the listed references from the included trials (13)(14)(15)(16)(17)(18)(19)(20)(21). Study selection for determining the eligibility for inclusion in the systematic review and subsequent data extraction were performed independently by two authors (L.M., C.C.)…”

Section: Methodsmentioning

confidence: 99%

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Real-Time Ultrasound Guidance as Compared With Landmark Technique for Subclavian Central Venous Cannulation: A Systematic Review and Meta-Analysis With Trial Sequential Analysis*

Zawadka

Via

Wong

et al. 2023

Critical Care Medicine

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OBJECTIVES:We conducted a systematic review and meta-analysis to assess the effectiveness of real-time dynamic ultrasound-guided subclavian vein cannulation as compared to landmark technique in adult patients.DATA SOURCES: PubMed and EMBASE until June 1, 2022, with the EMBASE search restricted to the last 5 years. STUDY SELECTION:We included randomized controlled trials (RCTs) comparing the two techniques (real-time ultrasound-guided vs landmark) for subclavian vein cannulation. The primary outcomes were overall success rate and complication rate, whereas secondary outcomes included success at first attempt, number of attempts, and access time.DATA EXTRACTION: Independent extraction by two authors according to prespecified criteria.DATA SYNTHESIS: After screening, six RCTs were included. Two further RCTs using a static ultrasound-guided approach and one prospective study were included in the sensitivity analyses. The results are presented in the form of risk ratio (RR) or mean difference (MD) with 95% CI. Real-time ultrasound guidance increased the overall success rate for subclavian vein cannulation as compared to landmark technique (RR = 1.14; [95% CI 1.06-1.23]; p = 0.0007; I 2 = 55%; low certainty) and complication rates (RR = 0.32; [95% CI 0.22-0.47]; p < 0.00001; I 2 = 0%; low certainty). Furthermore, ultrasound guidance increased the success rate at first attempt (RR = 1.32; [95% CI 1.14-1.54]; p = 0.0003; I 2 = 0%; low certainty), reduced the total number of attempts (MD = -0.45 [95% CI -0.57 to -0.34]; p < 0.00001; I 2 = 0%; low certainty), and access time ; p = 0.006; I 2 = 77%; low certainty). The Trial Sequential Analyses on the investigated outcomes showed that the results were robust. The evidence for all outcomes was considered to be of low certainty. CONCLUSIONS:Real-time ultrasound-guided subclavian vein cannulation is safer and more efficient than a landmark approach. The findings seem robust although the evidence of low certainty.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Real-Time Ultrasound Guidance as Compared With Landmark Technique for Subclavian Central Venous Cannulation: A Systematic Review and Meta-Analysis With Trial Sequential Analysis*

Zawadka

Via

Wong

et al. 2023

Critical Care Medicine

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“…The Seldinger technique exhibits precedence in the choice of physicians. To mitigate the risk of complications, the utilization of ultrasound guidance in visualizing the vessel has been proven to increase the success rate of the aforementioned procedure [ 4 ]. Cannulating the subclavian vein is part of common medical practice and offers particular advantages when compared to other access sites.…”

Section: Introductionmentioning

confidence: 99%

Lung deflation while placing a subclavian vein catheter: Our experience in minimizing the risk of pneumothorax

2023

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Purpose Lung deflation may reduce the risk of pneumothorax based on the assumption that the distance between the subclavian vein and the lung pleura would increase as well as the diameter of the vein. We aim to provide evidence to support the suggested desideratum of deflation in adults. Methods A prospective database was created that included patients who underwent subclavian vein catheterization for monitoring and therapeutic reasons from January 2014 to January 2020. Measurements using ultrasonography of the diameter of the subclavian vein were taken while the patient’s breathing was controlled by a ventilator and then repeated after disconnecting the mechanical ventilation and opening the pressure relief valve. Results A total of 123 patients were enrolled, with an average age of 41.9 years. The subclavian vein diameter was measured during controlled breathing with a mean average of 8.1 ± 0.6mm in males and 7.1 ± 0.5mm in females. The average increase after lung deflation with the pressure relief valve closed was 8.0± 5.1mm in males and 13.9 ± 5.4mm in females. An increase was noticed after opening a pressure valve, and the means were 5.5 ± 2.8mm in males and 5.1 ± 3.3mm in females. The catheter malposition rate was 0.8% Conclusion The benefit of interrupting mechanical ventilation and lung deflation lies within possibly avoiding pneumothorax as a complication of subclavian vein catheterization. These findings support the need for evidence regarding the curtailment of pneumothorax incidence in spontaneously breathing patients and the suggested increase in first-time punctures and success rates.

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Static Ultrasound Guidance VS. Anatomical Landmarks for Subclavian Vein Puncture in the Intensive Care Unit: A Pilot Randomized Controlled Study

Cited by 2 publications

References 37 publications

Real-Time Ultrasound Guidance as Compared With Landmark Technique for Subclavian Central Venous Cannulation: A Systematic Review and Meta-Analysis With Trial Sequential Analysis*

Real-Time Ultrasound Guidance as Compared With Landmark Technique for Subclavian Central Venous Cannulation: A Systematic Review and Meta-Analysis With Trial Sequential Analysis*

Lung deflation while placing a subclavian vein catheter: Our experience in minimizing the risk of pneumothorax

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