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Is external jugular vein cannulation feasible in emergency care? A randomised study in open heart surgery patients
Pasi Lahtinen1, Tadeusz Musialowicz, Harri Hyppölä
1Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland. pasi.lahtinen@kuh.fi
Insights
In emergencies, antecubital vein catheterization is faster and more successful than external jugular vein catheterization. This study compared the two sites for emergency venous access, finding antecubital veins superior for paramedics and residents.
Area of Science:
- Emergency Medicine
- Vascular Access
- Clinical Procedures
Background:
- Optimal intravenous catheterization sites in emergencies remain unclear.
- The external jugular vein is proposed as a potentially faster route due to quicker circulation to the heart.
- However, comparative data on catheterization time and success rates for different sites is lacking.
Purpose of the Study:
- To compare the catheterization time and success rates of external jugular vein versus antecubital vein catheterization.
- To evaluate the feasibility of these two venous access sites in emergency settings.
Main Methods:
- Paramedics and emergency department residents performed external jugular and antecubital venous catheterizations on anesthetized patients.
- The study measured catheterization time, failure rate, and the number of attempts required for success.
- 32 paramedics and 28 residents participated in the study.
Main Results:
- Antecubital vein catheterization was significantly faster (113±89s) than external jugular vein catheterization (156±112s).
- Success rates were higher for the antecubital vein (93%) compared to the external jugular vein (68%).
- Fewer attempts were needed for antecubital vein catheterization, with lower failure rates for both paramedics and residents.
Conclusions:
- Antecubital vein catheterization demonstrated a superior success rate and was faster than external jugular vein catheterization.
- These findings suggest the antecubital vein is a more effective site for emergency venous access.
- The study highlights the importance of site selection for efficient emergency procedures.
Unlabelled:
The optimal intravenous catheterisation site for emergencies is unknown. The external jugular vein might be preferable route compared to cubital veins in emergencies due to more rapid circulation time to heart and faster cardiac responses. However, the feasibility of the different venous catheterisation sites has not been compared in relation to catheterisation time and success rate.
Methods:
We examined the time differences and success rates of external jugular compared to antecubital vein catheterisations. 32 paramedics and 28 emergency department residents performed external jugular and antecubital venous catheterisations on anesthetized patients scheduled for elective cardiac surgery. The primary outcome was catheterisation time and the secondary outcomes the failure rate and catheterisation times needed to succeed.
Results:
Antecubital venous catheterisation was faster (113+/-89s) compared to external jugular vein catheterisation (156+/-112s), p=0.008 and the success rate was higher (93% compared to 68%, respectively, p=0.001). Less attempts were needed for antecubital vein catheterisations compared to external jugular vein catheterisations (p=0.002). For the antecubital vein, subjects needed two attempts in 6 patients and three attempts in 6 patients. For the external jugular vein, subjects needed two attempts in 13 patients and three attempts in 20 patients. Two (6%) paramedics and two (7%) residents failed to catheterise the antecubital vein. Nine (28%) paramedics and 10 (36%) residents failed to catheterise the external jugular vein.
Conclusions:
Antecubital vein catheterisation was faster and had a superior success rate compared to external jugular vein catheterisation.
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