Komplikationen und Erfolgsraten des Vena-subclavia-Katheters in Abhängigkeit der Erfahrung

Schulz, J.; Scholler, Axel; Frank, P; Scheinichen, Dirk; Flentje, M.; Eismann, Hendrik; Palmaers, Thomas

doi:10.1007/s00101-020-00888-2

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…Previous data indicate that operator training and experience are critical for successful cannulation and low complication rates [ 2 , 25 , 29 , 32 – 34 ]. This was confirmed in the previous study on the same cohort where limited operator experience was independently associated with a higher risk of both minor and major mechanical complications [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Operator gender differences in major mechanical complications after central line insertions: a subgroup analysis of a prospective multicentre cohort study

Naddi,

Hübinette,

Kander

et al. 2024

BMC Anesthesiol

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Background A previous study on mechanical complications after central venous catheterisation demonstrated differences in complication rates between male and female operators. The objective of this subgroup analysis was to further investigate these differences. The hypothesis was that differences in distribution of predefined variables between operator genders could be identified. Methods This was a subgroup analysis of a prospective, multicentre, observational cohort study conducted between March 2019 and December 2020 including 8 586 patients ≥ 16 years receiving central venous catheters at four emergency care hospitals. The main outcome measure was major mechanical complications defined as major bleeding, severe cardiac arrhythmia, pneumothorax, arterial catheterisation, and persistent nerve injury. Independent t-test and χ2 test were used to investigate differences in distribution of major mechanical complications and predefined variables between male and female operators. Multivariable logistic regression analysis was used to determine association between operator gender and major mechanical complications. Results Female operators had a lower rate of major mechanical complications than male operators (0.4% vs 0.8%, P = .02), were less experienced (P < .001), had more patients with invasive positive pressure ventilation (P < .001), more often chose the internal jugular vein (P < .001) and more frequently used ultrasound guidance (P < .001). Male operators more often chose the subclavian vein (P < .001) and inserted more catheters with bore size ≥ 9 Fr (P < .001). Multivariable logistic regression analysis showed that male operator gender was associated with major mechanical complication (OR 2.67 [95% CI: 1.26–5.64]) after correction for other relevant independent variables. Conclusions The hypothesis was confirmed as differences in distribution of predefined variables between operator genders were found. Despite being less experienced, female operators had a lower rate of major mechanical complications. Furthermore, male operator gender was independently associated with a higher risk of major mechanical complications. Future studies are needed to further investigate differences in risk behaviour between male and female operators. Trial registration Clinicaltrials.gov identifier: NCT03782324. Date of registration: 20/12/2018.

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Section: Discussionmentioning

confidence: 99%

Operator gender differences in major mechanical complications after central line insertions: a subgroup analysis of a prospective multicentre cohort study

Naddi,

Hübinette,

Kander

et al. 2024

BMC Anesthesiol

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“…Although a valuable skill, SCV cannulation using landmark technique is associated with patient safety risks. Most clinicians prefer ultrasound-guided IJV cannulation which permits visualization of the vessel (44). A study comparing ultrasound guidance and landmark technique for IJV and femoral access demonstrated that operators learning only the ultrasound-guided technique were not immediately able to perform the landmark technique (increased failure and complication rate).…”

Section: Discussionmentioning

confidence: 99%

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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Implementation of Ultrasound-Guided Infraclavicular Subclavian Venous Catheterization During Anesthesia and Elective Surgery: A Prospective Observational Study at a Single Center in Lithuania

et al. 2022

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Background:Ultrasound-guided procedures have become more reliable and efficient in daily anesthesiology practice, with increased patient comfort, better antimicrobial pattern, and easer care, and can be used in routine central vein catheterization practice. The infraclavicular subclavian vein approach provides all these advandages and in some clinical scenarios ensures the only appropriate route to central vein access. Therefore, this study of 105 patients aimed to implement and evaluate the use of ultrasound-guided infraclavicular subclavian venous catheterization. Material/Methods:We enrolled 108 patients who were scheduled for elective major abdominal surgery and had an indication for central venous access. Catheterization was done according to the developed protocol. Anesthesiologists with at least 1 year of experience in regional ultrasound-guided anesthesia participated in this study. Data were collected and compared with the existing literature. Results:Out of 108 patients enrolled, 3 were excluded due to unfulfilled protocol. The successful catheterization rate was 98.1%. A significant relationship with deeper and narrower vein and failure was noted. On average, the distance between the vein entry point and acoustic shadow of the clavicle was 10.45 mm, at this point the depth was 22.01 mm and the diameter of the vein was 10.74 mm. The length of catheter intratissue passage was 42.06 mm. The angle between the skin and catheter passage was 31.58°. The malposition rate was 8.7%, and no predictive factors were identified. Equations to predict vein diameter and depth were generated. Patient weight more than 119.5 kg predicted procedure failure. There were no complications. Conclusions:Ultrasound-guided infraclavicular subclavian vein catheterization can be easily and safely integrated into daily clinical practice, with high success rates and low complication rates.

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Komplikationen und Erfolgsraten des Vena-subclavia-Katheters in Abhängigkeit der Erfahrung

Cited by 3 publications

References 33 publications

Operator gender differences in major mechanical complications after central line insertions: a subgroup analysis of a prospective multicentre cohort study

Operator gender differences in major mechanical complications after central line insertions: a subgroup analysis of a prospective multicentre cohort study

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

Implementation of Ultrasound-Guided Infraclavicular Subclavian Venous Catheterization During Anesthesia and Elective Surgery: A Prospective Observational Study at a Single Center in Lithuania

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