ORIGINAL ARTICLE   Free access

Minerva Anestesiologica 2021 March;87(3):294-301

DOI: 10.23736/S0375-9393.20.14734-5

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Comparison of dynamic needle tip positioning versus conventional long-axis in-plane techniques for ultrasound-guided internal jugular venous catheterization: a randomized controlled trial

Seohee LEE ¹, Jee-Eun CHANG ², Yoomin OH ^{1, 2}, Hyo-Jun YANG ^{1, 2}, Jinyoung BAE ¹, Youn-Joung CHO ¹, Yunseok JEON ¹, Karam NAM ¹, Tae-Kyong KIM ² ✉

¹ Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea; ² Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea

BACKGROUND: Continuous visualization of the needle tip is essential for successful ultrasound-guided central venous catheterization, and the dynamic needle tip positioning (DNTP) technique enables it. The aim of this randomized, dual-center trial was to compare the first-attempt success rate of ultrasound-guided internal jugular catheterization between the DNTP and conventional long-axis in-plane (LAX-IP) techniques.
METHODS: Patients undergoing cardiac surgery at two tertiary teaching hospitals were randomly allocated to either the DNTP or LAX-IP group. Internal jugular venous catheterization was performed by four anesthesiologists. The primary outcome was the first-attempt success rate of central venous catheterization. Procedural time and complications related to catheterization were compared as secondary outcomes.
RESULTS: In total, 142 patients were analysed. The first-attempt success rate was significantly higher in the DNTP group (59/72, 81.9%) than in the LAX-IP group (46/70, 65.7%; odds ratio, 2.37; 95% confidence interval 1.09-5.15; P=0.028). In addition, the needle was redirected less frequently in the DNTP group than the LAX-IP group (P=0.026). Procedural time was comparable between the groups. No significant differences were observed in complications related to catheterization, including posterior wall puncture, carotid artery puncture, or hematoma.
CONCLUSIONS: The DNTP technique resulted in a significantly higher success rate on the first attempt at internal jugular venous catheterization and required less frequent redirection of the needle during the procedure than the conventional LAX-IP technique.

KEY WORDS: Cardiac surgical procedures; Catheterization, central venous; Complications; Ultrasonography