Minerva Anestesiologica 2020 Dec 15

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 catheterisation: a randomised controlled trial

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

¹ Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea; ² Department of Anaesthesiology and Pain Medicine, Seoul Metropolitan Government-Seoul
National University Boramae Medical Centre, Seoul National University College of Medicine, Seoul, Korea

BACKGROUND: Continuous visualisation of the needle tip is essential for successful ultrasound-guided central venous catheterisation, and the dynamic needle tip positioning (DNTP) technique enables it. The aim of this randomised, dual-centre trial was to compare the first-attempt success rate of ultrasound-guided internal jugular catheterisation 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 catheterisation was performed by four anaesthesiologists. The primary outcome was the firstattempt success rate of central venous catheterisation. Procedural time and complications related to catheterisation 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 catheterisation, including posterior wall puncture, carotid artery puncture, or haematoma.
CONCLUSIONS: The DNTP technique resulted in a significantly higher success rate on the first attempt at internal jugular venous catheterisation, and required less frequent redirection of the needle during the procedure than the conventional LAX-IP technique.

KEY WORDS: Cardiac surgical procedures; Central venous catheterisation; Complications; Internal jugular vein; Ultrasonography