중심정맥도관삽입술 시 위치이상의 빈도를 감소시키는 방법: 실시간 초음파 유도하 재위치
How to Decrease the Malposition Rate of Central Venous Catheterization: Real-Time Ultrasound-Guided Reposition
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Background: The purpose of this retrospective and prospective study is to evaluate the efficiency of ultrasound (US) guidance as a method of decreasing the malposition rate of central venous catheterization (CVC) in the emergency department (ED). Methods: We retrospectively enrolled 379 patients who underwent landmark-guided CVC (Group A) and prospectively enrolled 411 patients who underwent US-guided CVC (Group B) in the ED of a tertiary hospital. Malposition of the CVC tip is identified when the tip is not located in the superior vena cava (SVC). In Group B, we performed US-guided intravascular guide-wire repositioning and then confirmed the location of the CVC tip with chest radiography when the guide-wire was visible in any three other vessels rather than in the approached vessel. In the case of a guide-wire inserted into the right subclavian vein (SCV), the left SCV and both internal jugular veins (IJV) were referred to as the three other vessels. The two subject groups were compared in terms of the malposition rate using Fisher’s exact test (significance = p < 0.05)Results: There were 38 malposition cases out of a total of 790 CVCs. The malposition rates of Groups A and B were 5.5% (21) and 4.1% (17), respectively, and no statistically significant difference in malposition rate between the two groups was found. In Group B,the malposition rate was decreased from 4.1% (17) to 1.2% (5) after the guide-wire was repositioned with US guidance, which led to a statistically significant difference in malposition rate (p < 0.01). Conclusions: The authors concluded that repositioning the guide-wire with US guidance increased correct placement of central venous catheters toward the SVC.
Abstract
Background: The purpose of this retrospective and prospective study is to evaluate the efficiency of ultrasound (US) guidance as a method of decreasing the malposition rate of central venous catheterization (CVC) in the emergency department (ED). Methods: We retrospectively enrolled 379 patients who underwent landmark-guided CVC (Group A) and prospectively enrolled 411 patients who underwent US-guided CVC (Group B) in the ED of a tertiary hospital. Malposition of the CVC tip is identified when the tip is not located in the superior vena cava (SVC). In Group B, we performed US-guided intravascular guide-wire repositioning and then confirmed the location of the CVC tip with chest radiography when the guide-wire was visible in any three other vessels rather than in the approached vessel. In the case of a guide-wire inserted into the right subclavian vein (SCV), the left SCV and both internal jugular veins (IJV) were referred to as the three other vessels. The two subject groups were compared in terms of the malposition rate using Fisher’s exact test (significance = p < 0.05)Results: There were 38 malposition cases out of a total of 790 CVCs. The malposition rates of Groups A and B were 5.5% (21) and 4.1% (17), respectively, and no statistically significant difference in malposition rate between the two groups was found. In Group B,the malposition rate was decreased from 4.1% (17) to 1.2% (5) after the guide-wire was repositioned with US guidance, which led to a statistically significant difference in malposition rate (p < 0.01). Conclusions: The authors concluded that repositioning the guide-wire with US guidance increased correct placement of central venous catheters toward the SVC.
참고문헌 (27)
- Boardman P, "Radiological evaluation and management of malfunctioning central venous catheters", Clin Radiol, 53, pp.10~16 (1998)
- Sznajder JI, "Central vein catheterization. Failure and complication rates by three percutaneous approaches", Arch Intern Med, 146, pp.259~261 (1986)
- Skolnick ML, "The role of sonography in the placement and management of jugular and subclavian central venous catheters", AJR Am J Roentgenol, 163, pp.291~295 (1994)
- Gladwin MT, "Cannulation of the internal jugular vein: is postprocedural chest radiography always necessary?", Crit Care Med, 27, pp.1819~1823 (1999)
- Jeon Y, "Transesophageal echocardiographic evaluation of ECG-guided central venous catheter placement", Can J Anaesth, 53, pp.978~983 (2006)
- Andropoulos DB, "A controlled study of transesophageal echocardiography to guide central venous catheter placement in congenital heart surgery patients", Anesth Analg, 89, pp.65~70 (1999)
- Reynolds N, "Assessment of distal tip position of long-term central venous feeding catheters using transesophageal echocardiology", JPEN J Parenter Enteral Nutr, 25, pp.39~41 (2001)
- Killu K, "Using Ultrasound to Identify the Central Venous Catheter Tip in the Superior Vena Cava", Icu Director, 1, pp.220~222 (2010)
- Tripathi M, "Direction of the J-tip of the guidewire, in seldinger technique, is a significant factor in misplacement of subclavian vein catheter: a randomized, controlled study", Anesth Analg, 100, pp.21~24 (2005)
- Kang M, "Influence of shoulder position on central venous catheter tip location during infraclavicular subclavian approach", Br J Anaesth, 106, pp.344~347 (2011)
- Milling TJ Jr, "Randomized, controlled clinical trial of point-of-care limited ultrasonography assistance of central venous cannulation: the Third Sonography Outcomes Assessment Program (SOAP-3) Trial", Crit Care Med, 33, pp.1764~1769 (2005)
- Matsushima K, "Detection of central venous catheter insertion-related complication using bedside ultrasound: the CVC sono", J Trauma, 70, pp.1561~1563 (2011)
- Hind D, "Ultrasonic locating devices for central venous cannulation: meta-analysis", BMJ, 327, pp.361~ (2003)
- Kremser J, "Optimized method for correct left-sided central venous catheter placement under electrocardiographic guidance", Br J Anaesth, 107, pp.567~572 (2011)
- McGee WT, "Accurate placement of central venous catheters: a prospective, randomized, multicenter trial", Crit Care Med, 21, pp.1118~1123 (1993)
- Collier PE, "Cardiac tamponade from central venous catheters", Am J Surg, 176, pp.212~214 (1998)
- Conces DJ Jr, "Aberrant locations and complications in initial placement of subclavian vein catheters", Arch Surg, 119, pp.293~295 (1984)
- Rosa UW, "Intermittent back pain after central venous catheter placement", JPEN J Parenter Enteral Nutr, 17, pp.91~93 (1993)
- Bagwell CE, "Potentially lethal complications of central venous catheter placement", J Pediatr Surg, 35, pp.709~713 (2000)
- Ruesch S, "Complications of central venous catheters: internal jugular versus subclavian access-a systematic review", Crit Care Med, 30, pp.454~460 (2002)
- Iovino F, "Central venous catheterization: complications of different placements", Ann Chir, 126, pp.1001~1006 (2001)
- Ambesh SP, "Internal jugular vein occlusion test for rapid diagnosis of misplaced subclavian vein catheter into the internal jugular vein", Anesthesiology, 95, pp.1377~1379 (2001)
- Muhm M, "Malposition of central venous catheters. Incidence, management and preventive practices", Wien Klin Wochenschr, 109, pp.400~405 (1997)
- Fragou M, "Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: a prospective randomized study", Crit Care Med, 39, pp.1607~1612 (2011)
- Ambesh SP, "Manual occlusion of the internal jugular vein during subclavian vein catheterization: a maneuver to prevent misplacement of catheter into internal jugular vein", Anesthesiology, 97, pp.528~529 (2002)
- Calvert N, "Ultrasound for central venous cannulation: economic evaluation of cost-effectiveness", Anaesthesia, 59, pp.1116~1120 (2004)
- Vesely TM, "Central venous catheter tip position: a continuing controversy", J Vasc Interv Radiol, 14, pp.527~534 (2003)