A randomized clinical trial of ultrasound-guided infra-clavicular cannulation of the subclavian vein in cardiac surgical patients: short-axis versus long-axis approach

Vezzani, Antonella; Manca, Tullio; Brusasco, Claudia; Santori, Gregorio; Cantadori, Luca; Ramelli, Andrea; Gonzi, Gianluca; Nicolini, Francesco; Gherli, Tiziano; Corradi, Francesco

doi:10.1007/s00134-017-4756-6

Cited by 43 publications

(31 citation statements)

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“…A recent RCT reported that the success rate of ultrasound-guided central venous catheterization in the subclavian vein was significantly higher when using SA than when using LA [ 23 ], which seems contradictory to our results. We speculate that the differences could be due to methodology: the procedure was performed 1) in real patients and 2) not by a novice operator.…”

Section: Discussioncontrasting

confidence: 99%

Combined short- and long-axis ultrasound-guided central venous catheterization is superior to conventional techniques: A cross-over randomized controlled manikin trial

et al. 2017

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ObjectivesVisualizing the needle tip using the short-axis (SA) ultrasound-guided central venous catheterization approach can be challenging. It has been suggested to start the process with the SA approach and then switch to the long-axis (LA); however, to our knowledge, this combination has not been evaluated. We compared the combined short- and long-axis (SLA) approach with the SA approach in a manikin study.MethodsWe performed a prospective randomized controlled cross-over study in an urban emergency department and intensive care unit. Resident physicians in post-graduate years 1–2 performed a simulated ultrasound-guided internal jugular vein puncture using the SA and SLA approaches on manikins. Twenty resident physicians were randomly assigned to two equal groups: (1) one group performed punctures using the SA approach followed by SLA; and (2) the other performed the same procedures in the opposite order. We compared the success rate and procedure duration for the two approaches. Procedural success was defined as insertion of the guide-wire into the vein while visualizing the needle tip at the time of anterior wall puncture, without penetrating the posterior wall.ResultsSix resident physicians (30%) performed both approaches successfully, while 12 (60%) performed the SLA approach, but not the SA, successfully. Those who performed the SA approach successfully also succeeded with the SLA approach. Two resident physicians (10%) failed to perform both approaches. The SLA approach had a significantly higher success rate than the SA approach (P < 0.001). The median (interquartile range) procedure duration was 59.5 [46.0–88.5] seconds and 45.0 [37.5–84.0] seconds for the SLA and SA approaches, respectively. The difference of the duration between the two procedures was 15.5 [0–28.5] seconds. There was no significant difference in duration between the two approaches (P = 0.12).ConclusionsUsing the SLA approach significantly improved the success rate of internal jugular vein puncture performed by novice physicians on a manikin model, without increasing procedural duration. Further clinical trials are warranted to confirm the procedure’s utility in actual patients.Trial registrationUMIN Clinical Trials Registry UMIN000026199

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Section: Discussioncontrasting

confidence: 99%

Combined short- and long-axis ultrasound-guided central venous catheterization is superior to conventional techniques: A cross-over randomized controlled manikin trial

et al. 2017

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“…Indeed, the goal of our study was to assess the anatomy surrounding the axillary vein and not the feasibility of echo-guided subclavian access per se. In a recent study by Vezzani et al 8 of 190 patients, the authors observed a 100% success rate in cannulation when performed by experienced anesthesiologists. In addition, they showed more complications using a long-axis compared to a short-axis approach.…”

Section: Limitationsmentioning

confidence: 97%

Subclavian and axillary vessel anatomy: a prospective observational ultrasound study

Lavallée

Ayoub

Mansour

et al. 2017

Can J Anesth/J Can Anesth

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“…In the internal jugular vein (IJV) subgroup, 17 , 20 , 22 , 23 the total success rate was also no different between the SA-OOP and LA-IP groups (RR, 1.00; 95% CI, 0.98–1.02; P =0.99; I 2 =0%; Figure 3 ) and the TSA also confirmed the result (the cumulative Z-curve crossed the futility boundary and entered the futility area; Figure 4B ). Only one study 25 was included in the subclavian vein (SCV) subgroup, and the results show that the SA-OOP approach was more efficacious than the LA-IP approach in increasing the total success rate (RR, 1.23; 95% CI, 1.10–1.38; P <0.01; Figure 3 ).…”

Section: Resultsmentioning

confidence: 99%

Comparison between the long-axis/in-plane and short-axis/out-of-plane approaches for ultrasound-guided vascular catheterization: an updated meta-analysis and trial sequential analysis

Liu

Mao

Kang

et al. 2018

TCRM

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BackgroundA long-axis in-plane (LA-IP) approach and a short-axis out-of-plane (SA-OOP) approach are the two main approaches used in ultrasound (US)-guided vascular catheterization. However, the efficacy and safety of these approaches remain controversial. Therefore, we performed this meta-analysis to compare the two techniques in vascular catheterization.Materials and methodsRelevant studies were searched in PubMed, Embase, and the Cochrane Library databases from database inception until August 2017. Randomized controlled trials comparing a long-axis approach with a short-axis approach for US-guided vascular cannulation were selected. The RevMan software was used to analyze the results, and trial sequential analysis (TSA) was further applied to determine whether the currently available evidence was sufficient and conclusive.ResultsEleven studies met the inclusion criteria. Overall, 1,210 patients were included. The total success rate was similar between the SA-OOP and LA-IP approaches for US-guided vascular catheterization (risk ratio [RR], 1.01; 95% CI, 0.99–1.04; P=0.35; I2=48%). In the radial artery (RA; RR, 1.00; 95% CI, 0.96–1.05; P=0.88; I2=49%) and internal jugular vein (IJV; RR, 1.00; 95% CI, 0.98–1.02; P=0.99; I2=0%) subgroups, the total success rate was also similar and was confirmed by the TSA. For populations with subclavian vein (SCV) and axillary vein catheterization, the SA-OOP approach showed a benefit for first-attempt success rate. No significant differences in first-attempt success rate, cannulation times, or complications were found between the two approaches.ConclusionDespite a similar total success rate between the SA-OOP approach and the LA-IP approach when used for RA and IJV catheterization (as confirmed by TSA), further robust well-designed trials are warranted to evaluate other outcomes. There is insufficient evidence to definitively state that the SA-OOP approach was superior to the LA-IP approach when used for SCV and axillary vein catheterization. High-quality trials are needed to confirm or refute this finding.

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A randomized clinical trial of ultrasound-guided infra-clavicular cannulation of the subclavian vein in cardiac surgical patients: short-axis versus long-axis approach

Abstract: The short-axis procedure for ultrasound-guided subclavian cannulation offers advantages over the long-axis approach in cardiac surgery patients.

Cited by 43 publications

References 24 publications

Combined short- and long-axis ultrasound-guided central venous catheterization is superior to conventional techniques: A cross-over randomized controlled manikin trial

Combined short- and long-axis ultrasound-guided central venous catheterization is superior to conventional techniques: A cross-over randomized controlled manikin trial

Subclavian and axillary vessel anatomy: a prospective observational ultrasound study

Comparison between the long-axis/in-plane and short-axis/out-of-plane approaches for ultrasound-guided vascular catheterization: an updated meta-analysis and trial sequential analysis

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