Ramírez-Velásquez JE, Hurtado-López LM

Language: Spanish
References: 15
Page: 84-88
PDF size: 81.96 Kb.

ABSTRACT

Objective: To compare which central venous vascular approach technique is better performed by medical residents.
Setting: Hospital General de México.
Design: Prospective, comparative, randomized.
Statistical analysis: Percentages as summary measure for qualitative variables. Student’s t test and chi square (χ²).
Material and methods: The access route for a central venous catheter placement was alternated between a jugular (group 1, G1) and a subclavial approach (group 2, G2), in a 5-month period. Studied variables were: age, gender, number of punctures according to approach, number of complications with the jugular approach, number of complications with the subclavial approach, acute complications, late complications, body mass index (BMI), number of punctures according to the year of residency, changes in type of technique, and side to be punctured. All catheters were placed by general surgery residents, assisted by a surgeon with expertise in vascular approaches.
Results: Group 1 consisted of 20 patients; 65% of punctures were performed in two or less attempts, mostly by 1^st and 2^nd year residents. There were four arterial punctures (20%), with one hematoma due to arterial puncture (5%). Two patients coursed with infection at the puncture site (10%) with Staphylococcus aureus on the 7^th day and another with. Serratia at 21 days in the cultures of the catheter’s tip. One catheter was misplaced (5%) and was re-placed without complications. The BMI for G1 was in average of 26.3 (range 19-46.7). Group 2 was constituted by 23 patients; 82.6% of punctures were achieved in two or less attempts, mostly performed by 1^st and 2^nd year residents. There were four arterial punctures (17.4%). No cases of thrombosis or infection were encountered in this group. The BMI of G2 patients was in average of 23.7 (range 17.4 – 31.4). There were no statistically significant differences when comparing the assessed variables between both groups.
Conclusion: There was no difference in complications between the central venous posterior jugular and the subclavial approach performed by resident physicians.

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