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Comparing short-, long-, and oblique-axis approaches to ultrasound-guided internal jugular venous catheterization: A
Jen-Yin Chen1, Li-Kai Wang, Yao-Tsung Lin
1From the Department of Anesthesiology (J-Y.C., L-K.W., Y-T.L., K-M.L.), Chi Mei Medical Center; Department of Senior Citizen Service Management (J-Y.C.), Chia Nan University of Pharmacy and Science, Tainan; Department of Food Science and Applied Biotechnology (Y-T.L., K-M.L.), National Chung Hsing University, Taichung, Taiwan; Center for Evidence-Based Health Care (E-W.L., K-W.T.), Department of Medical Research (E-W.L., K-W.T.), Taipei Medical University-Shuang Ho Hospital, New Taipei City; School of Medicine (C-H.C.), College of Medicine, Division of General Surgery, Department of Surgery (K-W.T.), School of Medicine, College of Medicine, Taipei Medical University, Taipei; Division of General Surgery, Department of Surgery (K-W.T.), Taipei Medical University-Shuang Ho Hospital, New Taipei City; and Cochrane Taiwan (K-W.T.), Taipei Medical University, Taipei, Taiwan.
Background:
Internal jugular venous catheterization is performed for numerous therapeutic interventions. Although ultrasound-guided internal jugular venous catheterization is the gold standard for this procedure, complications can still occur. Various scanning axes, namely, the short axis (SA), long axis (LA), and oblique axis (OA), have been developed to ameliorate these complications. This study compared the efficacy and safety of SA, LA, and OA approaches.
Methods:
PubMed, Embase, and Cochrane Library databases were searched for studies published before September 2018. Only randomized controlled trials were included. We conducted meta-analyses using a random-effects model. Treatment efficacy was measured by total success rate, first-pass success rate, number of needle passes, and incidence of complications, namely, arterial puncture, hematoma, and catheter-related bloodstream infection.
Results:
Six randomized controlled trials with 621 patients were included. No significant differences were observed in total success rate and first-pass success rate, as well as in the arterial puncture, hematoma, or catheter-related bloodstream infection complications between SA and LA approaches. Moreover, no significant difference was found between SA and OA approaches in terms of total success rate, first-pass success rate, number of needle passes, and complications of arterial puncture and hematoma. However, the number of needle passes was significantly fewer in SA approach than in LA approach (weighted mean difference, -0.18; 95% confidence interval, -0.35 to -0.01).
Conclusion:
None of the scanning axes exhibited unique features that could enhance their suitability for application. Hence, scanning axes should be selected by considering various factors that include patient characteristics, clinician expertise, and ease of procedures.
Level Of Evidence:
Systematic review and meta-analysis, level I.
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