A Shallow Angle Short-Axis Out-of-Plane Approach Reduces the Rate of Posterior Wall Injuries in Central Venous Catheterization: A Simulation Study

• Published in: BioMed research international Vol. 2018; no. 2018; pp. 1 - 5
• Main Authors: Moriyama, Kumi, Motoyasu, Akira, Lefor, Alan T., Tokumine, Joho, Watanabe, Kunitaro, Yorozu, Tomoko
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Hindawi Publishing Corporation 01.01.2018; Hindawi; John Wiley & Sons, Inc
• Subjects: Anesthesia; Catheterization; Catheterization, Central Venous - methods; Catheters; Clinical Study; Comparative analysis; Critical care; Electronics in navigation; Emergency medical care; Health risks; Humans; Injuries; Injury analysis; Injury prevention; Intubation; Jugular vein; Jugular Veins - injuries; Medical students; Prospective Studies; Simulation; Success; Ultrasonic imaging; Ultrasonography, Interventional; Ultrasound; Veins & arteries; Japan
• ISSN: 2314-6133; 2314-6141; 2314-6141
• DOI: 10.1155/2018/4793174

The short-axis out-of-plane approach (SAX-OOP) is commonly used in ultrasound-guided internal jugular vein catheterization. However, this approach has a risk of posterior vein wall injuries. The authors hypothesized that a shallow angle of approach may reduce the rate of posterior wall injuries compared with the conventional steep angle approach. The present study aimed to evaluate whether a difference in the angle of approach of the needle affects the rate of posterior wall injuries. The present study was a randomized crossover-controlled trial involving 40 medical residents, conducted in the clinical training center at a hospital with a residency program. The primary outcome measure was the rate of posterior vessel wall injuries. Subjects received a didactic lecture during which the instructors taught three SAX-OOP techniques including the conventional free-hand method (procedure C), a needle navigation system (procedure N), and a shallow puncture angle using a guidance system (procedure S). Participants were trained in these approaches under supervision and each technique tested in a simulation environment. Thirty-four of 40 residents had no previous experience with central venous catheterization and were included in the final analysis. The rate of posterior vessel wall injuries in procedure S (9%) was significantly lower than using the other approaches (procedure C, 53%; procedure N, 41%). In conclusion, a shallow angle of approach using the SAX-OOP technique resulted in significantly fewer posterior vein wall injuries in central venous catheterization compared with steep angle techniques.