Ramírez TJ, Montelongo FJ, Tapia VR, Galindo AJ, Trujillo MM, Martínez RAI

Language: Spanish
References: 9
Page: 469-472
PDF size: 242.22 Kb.

ABSTRACT

Introduction: central venous access is one of the most used procedures in the health area, that is why almost 90% of patients admitted to the intensive care unit require a central venous access, and in some cases with urgency such as the subclavian or jugular vein, which is frequently placed guided by anatomical references. In addition, the introduction of Point-of-care ultrasonography to guide vascular accesses, allows it to be a tool to perform the procedure in the medical area in a safe way. Therefore, the purpose of our research is to propose the ultrasound-guided supraclavicular approach as an alternative in critically ill patients. Material and methods: a pilot, prospective, transversal and analytical study was carried out in patients of the intensive care unit of the Hospital General "Las Américas" of the Instituto de Salud del Estado de México, with the use of wireless Siemens Acuson Freestyle ultrasound with linear transducer 7-13 MHz and trilumen or bilumen central venous catheter of 7 French diameter and twenty centimeters in length. Results: the success of supraclavicular central venous catheter placement guided by ultrasound was 86.66%, with an average of 40 seconds from insertion into the skin to placement of the guidewire into the subclavian vein. There were limitations in placement such as installation failure in 13% due to anatomical variants and presence of thrombus in the subclavian vein, and complications such as arterial puncture in 10% and pneumothorax in 3% of the sample of 30 patients. Conclusions: placement for supraclavicular central venous access guided by ultrasound is an alternative technique that we propose for patients in the critical area.

REFERENCES

1. Practice Guidelines for Central Venous Access 2020: An Updated Report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology. 2020;132(1):8-43. doi: 10.1097/ALN.0000000000002864.

2. Fragou M, Gravvanis A, Dimitriou V, Papalois A, Kouraklis G, Karabinis A, et al. Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: A prospective randomized study. Crit Care Med [Internet]. 2011;39(7):1607-1612. Available in: http://dx.doi.org/10.1097/ccm.0b013e318218a1ae

3. Yoffa D. Supraclavicular subclavian venepuncture and catheterisation. Lancet. 1965;2(7413):614-617.

4. Prasad R, Soni S, Janweja S, Rajpurohit JS, Nivas R, Kumar J. Supraclavicular or infraclavicular subclavian vein: Which way to go- A prospective randomized controlled trial comparing catheterization dynamics using ultrasound guidance. Indian J Anaesth. 2020;64(4):292-298. doi: 10.4103/ija.IJA_930_19.

5. Guía de Práctica Clínica Prevención, diagnóstico y tratamiento de las infecciones relacionadas a líneas vasculares. México: Instituto Mexicano del Seguro Social; 2013.

6. Zarskus A, Zykuté D, Trepenaitis D, Macas A. Implementation of ultrasound-guided infraclavicular subclavian venous catheterization during anesthesia and elective surgery: a prospective observational study at a single center in Lithuania. Med Sci Monit. 2023;29:e938851. doi: 10.12659/MSM.938851.

7. Brown DC, Gonzalez-Vargas JM, Tzamaras HM, Sinz EH, Ng PK, Yang MX, et al. Evaluating the impact of assessment metrics for simulated central venous catheterization training. Simul Healthc [Internet]. 2024;19(1):2-34. Available in: https://journals.lww.com/simulationinhealthcare/abstract/2024/02000/evaluating_the_impact_of_assessment_metrics_for.4.aspx

8. Raphael PO, Simon BP, Thankappan C, Chacko L. Comparison between ultrasound-guided supraclavicular and infraclavicular approaches for subclavian venous catheterisation in adults. J Evid Based Med Healthc [Internet]. 2016;3(36):1774-1778. Available in: http://dx.doi.org/10.18410/jebmh/2016/397

9. Saini V, Vamsidhar A, Samra T, Sethi S, Naik BN. Evaluación comparativa de cateterismos venosos subclavicular e infraclavicular guiado por ultrasonido en pacientes adultos. J Anaesthesiol Clin Pharmacol. 2022;38(3):411-416. doi: 10.4103/joacp.JOACP_400_20.