Venepuncture, catheterization and failure to position correctly during central venous cannulation.

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Anesthesiology

Background:

• Central venous catheterization is a common procedure.
• Multiple transcutaneous approaches exist, each with varying success and complication rates.

Purpose of the Study:

• To compare the efficacy and safety of six different transcutaneous approaches for central venous catheterization.
• To identify the optimal approach for central venous catheter insertion.

Main Methods:

• Analysis of 420 central venous catheterizations in 388 patients.
• Evaluation of six approaches: supraclavicular subclavian, infraclavicular subclavian, internal jugular, external jugular, antecubital, and brachiocephalic.
• Recording of puncture, catheterization, and positioning failure rates.

Main Results:

• Puncture failure rate: 7.9% (36/456 attempts).
• Catheterization failure rate: 5.8% (26/446 attempts).
• Misplacement rate: 5.7% (23/420 catheterizations).
• Supraclavicular subclavian approach showed the highest success rates.
• Antecubital and external jugular approaches had high failure and misplacement rates.
• Patient positioning (sitting) significantly improved antecubital vein success rates.

Conclusions:

• The supraclavicular subclavian approach is recommended preferentially for central venous catheterization.
• Internal jugular, brachiocephalic, and infraclavicular subclavian approaches are also advantageous.
• Antecubital and external jugular approaches should be used cautiously, with patient positioning being a key factor for the former.