Effects of ultrasound-guided ipsilateral internal jugular vein compression on catheter malposition during ultrasound-guided right infraclavicular subclavian venous catheterisation: a randomised controlled trial.
TL;DR
It is found that catheter malposition occurred less frequently in the IJV compression group, and can be an effective intervention to prevent catheter malposition during ultrasound-guided right infraclavicular subclavian venous catheterisation.
Abstract
INTRODUCTION Central venous catheter malposition into the ipsilateral internal jugular vein (IJV) is an unresolved concern in ultrasound-guided right infraclavicular subclavian venous catheterisation. We sought to investigate whether ultrasound-guided ipsilateral IJV compression during guidewire advancement reduces catheter malposition during this procedure.
Methods
Adult patients undergoing elective neurosurgical procedures requiring an ultrasound-guided right infraclavicular subclavian venous catheterisation were included in this study. Patients were assigned randomly to the IJV compression group or control group. In patients assigned to the IJV compression group, external compression was applied with an ultrasound probe to physically collapse the ipsilateral proximal IJV during guidewire advancement. The primary outcome was the incidence of overall catheter malposition. Secondary outcomes included the incidence of other catheterisation-related complications (e.g. catheter malposition into the ipsilateral internal jugular or contralateral brachiocephalic veins) and catheterisation performance indices (e.g. catheterisation time).
Results
A total of 157 and 158 patients were assigned randomly to the IJV compression and control groups, respectively. Overall, we found that catheter malposition occurred less frequently in the IJV compression group (9/157 (6%) vs. 20/158 (13%); difference in proportions -6.9%, 95%CI -13.3% to -0.6%; OR 0.42, 95%CI 0.18-0.95; p = 0.034). Except for longer median (IQR [range]) catheterisation times in the IJV compression group (139 (114-172 [48-298]) s vs. 114 (90-150 [50-274]) s; p < 0.001), other between-group differences in the secondary outcomes were not significant. All instances of catheter malposition into the ipsilateral IJV were corrected successfully by guidewire reinsertion under ultrasound-guided ipsilateral IJV compression with maximal force.
Discussion
Ultrasound-guided ipsilateral IJV compression during guidewire advancement can be an effective intervention to prevent catheter malposition during ultrasound-guided right infraclavicular subclavian venous catheterisation.