한빛사 논문
Hyun-Jung Shin1, Hyo-Seok Na1, Won-Uk Koh2, Young-Jin Ro2, Jung-Man Lee3, Yoon-Ji Choi4, Seongjoo Park1, Jin-Hee Kim1,5,*
1. Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, South Korea
2. Department of Anesthesiology and Pain Medicine, Asan Medical Center, Seoul, South Korea
3. Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
4. Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan-si, South Korea
5. Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea
*To whom correspondence should be addressed.
Abstract
Purpose
The use of real-time ultrasound (US) has been shown to reduce complications of central venous (CV) catheterization. However, complication rates have not been compared according to insertion points for CV catheterization using US. Accordingly, this study aimed to compare the complication rates of internal jugular vein (IJV) with those of subclavian vein (SCV) catheterization.
Methods
Three tertiary academic hospitals in South Korea participated in this multicenter, randomized study. A total of 1484 patients were preoperatively randomized into two groups. The IJV group (n = 742) was cannulated via the right IJV, and the SCV group (n = 742) was cannulated via the right SCV under US guidance. The primary outcome measure was total complication rate. Secondary outcomes included access time for the first attempt, number of attempts, and catheter position.
Results
The total complication rate did not demonstrate a significant difference between the IJV (0.1%) and SCV (0.7%) groups (P = 0.248). In the IJV group, arterial puncture occurred in 0.1% of patients; in the SCV group, arterial puncture occurred in 0.6% and pneumothorax in 0.1%. The success rate on the first attempt was significantly higher in the IJV group (98.4%) than in the SCV group (95.9%) (P = 0.004). The access time for the first attempt (P < 0.001) and the median number of attempts (P = 0.006) were significantly lower in the IJV group than in the SCV group. More catheter misplacements were observed in the SCV group (5.9%) than in the IJV group (0.4%) (P < 0.001).
Conclusion
Results demonstrated that the complication rates of IJV and SCV catheterizations using US are very low, showing no superiority of the SCV approach compared to the IJV.
Keywords : Central venous catheterization, Jugular vein, Subclavian vein, Ultrasound, Complication
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