Biomaterial Database

Ultrasound-Guided Infraclavicular Axillary Vein Versus Internal Jugular Vein Cannulation in Critically Ill Mechanically Ventilated Patients: A Randomized Trial. 2023

Tomasz Czarnik, and Miroslaw Czuczwar, and Michal Borys, and Olimpia Chrzan, and Kamil Filipiak, and Magdalena Maj, and Maciej Marszalski, and Marta Miodonska, and Maciej Molsa, and Marek Pietka, and Maciej Piwoda, and Pawel Piwowarczyk, and Zuzanna Rogalska, and Jakub Stachowicz, and Ryszard Gawda

Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland.

OBJECTIVE This clinical trial aimed to compare the ultrasound-guided in-plane infraclavicular cannulation of the axillary vein (AXV) and the ultrasound-guided out-of-plane cannulation of the internal jugular vein (IJV). METHODS A prospective, single-blinded, open label, parallel-group, randomized trial. METHODS Two university-affiliated ICUs in Poland (Opole and Lublin). METHODS Mechanically ventilated intensive care patients with clinical indications for central venous line placement. METHODS Patients were randomly assigned into two groups: the IJV group ( n = 304) and AXV group ( n = 306). The primary outcome was to compare the IJV group and AXV group through the venipuncture and catheterization success rates. Secondary outcomes were catheter tip malposition and early mechanical complication rates. All catheterizations were performed by advanced residents and consultants in anesthesiology and intensive care. RESULTS The IJV puncture rate was 100%, and the AXV was 99.7% (chi-square, p = 0.19). The catheterization success rate in the IJV group was 98.7% and 96.7% in the AXV group (chi-square, p = 0.11). The catheter tip malposition rate was 9.9% in the IJV group and 10.1% in the AXV group (chi-square, p = 0.67). The early mechanical complication rate in the IJV group was 3% (common carotid artery puncture-4 cases, perivascular hematoma-2 cases, vertebral artery puncture-1 case, pneumothorax-1 case) and 2.6% in the AXV group (axillary artery puncture-4 cases, perivascular hematoma-4 cases) (chi-square, p = 0.79). CONCLUSIONS No difference was found between the real-time ultrasound-guided out-of-plane cannulation of the IJV and the infraclavicular real-time ultrasound-guided in-plane cannulation of the AXV. Both techniques are equally efficient and safe in mechanically ventilated critically ill patients.

UI	MeSH Term	Description	Entries
D007601	Jugular Veins	Veins in the neck which drain the brain, face, and neck into the brachiocephalic or subclavian veins.	Jugular Vein,Vein, Jugular,Veins, Jugular
D011446	Prospective Studies	Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.	Prospective Study,Studies, Prospective,Study, Prospective
D012121	Respiration, Artificial	Any method of artificial breathing that employs mechanical or non-mechanical means to force the air into and out of the lungs. Artificial respiration or ventilation is used in individuals who have stopped breathing or have RESPIRATORY INSUFFICIENCY to increase their intake of oxygen (O2) and excretion of carbon dioxide (CO2).	Ventilation, Mechanical,Mechanical Ventilation,Artificial Respiration,Artificial Respirations,Mechanical Ventilations,Respirations, Artificial,Ventilations, Mechanical
D002405	Catheterization, Central Venous	Placement of an intravenous CATHETER in the subclavian, jugular, or other central vein.	Central Venous Catheterization,Venous Catheterization, Central,Catheterization, Central,Central Catheterization,Catheterizations, Central,Catheterizations, Central Venous,Central Catheterizations,Central Venous Catheterizations,Venous Catheterizations, Central
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001367	Axillary Vein	The venous trunk of the upper limb; a continuation of the basilar and brachial veins running from the lower border of the teres major muscle to the outer border of the first rib where it becomes the subclavian vein.	Axillary Veins,Vein, Axillary,Veins, Axillary
D016638	Critical Illness	A disease or state in which death is possible or imminent.	Critically Ill,Critical Illnesses,Illness, Critical,Illnesses, Critical
D018084	Ultrasonography, Interventional	The use of ultrasound to guide minimally invasive surgical procedures such as needle ASPIRATION BIOPSY; DRAINAGE; etc. Its widest application is intravascular ultrasound imaging but it is useful also in urology and intra-abdominal conditions.	Ultrasonography, Intravascular,Ultrasound, Interventional,Interventional Ultrasonography,Intravascular Ultrasonography,Interventional Ultrasound