Internal jugular venous catheterization (IJVC) is performed for numerous therapeutic interventions. Although ultrasound-guided IJVC is the gold standard for this procedure, complications can still occur” Chen et al (2018).
BACKGROUND: Internal jugular venous catheterization (IJVC) is performed for numerous therapeutic interventions. Although ultrasound-guided IJVC is the gold standard for this procedure, complications can still occur. Various scanning axes, namely the short axis (SA), long axis (LA), and oblique axis (OA), have been developed to ameliorate these complications. This study compared the efficacy and safety of SA, LA, and OA approaches.
METHODS: PubMed, Embase, and Cochrane Library databases were searched for studies published before September 2018. Only randomized controlled trials (RCTs) were included. We conducted meta-analyses using a random effects model. Treatment efficacy was measured by total success rate, first pass success rate, number of needle passes, and incidence of complications, namely arterial puncture, hematoma and catheter-related bloodstream infection (CRBSI).
RESULTS: Six RCTs with 621 patients were included. No significant differences were observed in total success rate and first pass success rate, as well as in the arterial puncture, hematoma, or CRBSI complications between SA and LA approaches. Moreover, no significant difference was found between SA and OA approaches in terms of total success rate, first pass success rate, number of needle passes, and complications of arterial puncture and hematoma. However, number of needle passes was significantly fewer in SA approach than in LA approach (weighted mean difference: -0.18; 95% confidence interval: -0.35, -0.01).
CONCLUSIONS: None of the scanning axes exhibited unique features that could enhance their suitability for application. Hence, scanning axes should be selected by considering various factors that include patient characteristics, clinician expertise, and ease of procedures.
LEVEL OF EVIDENCE: Systematic review and meta-analysis, level I.
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Chen, J.Y., Wang, L.K., Lin, Y.T., Lan, K.M., Loh, E.W., Chen, C.H. and Tam, K.W. (2018) Comparing Short-, Long-, and Oblique-Axis Approaches to Ultrasound-Guided Internal Jugular Venous Catheterization: A Meta-Analysis of Randomized Controlled Trials. The Journal of Trauma and Acute Care Surgery. November 30th. .