背景:超声引导的中心静脉导管插入术(CVC)已成为护理标准。然而,提供者使用各种方法,包括颈内静脉(IJV),锁骨上锁骨下静脉(SupraSCV),锁骨下锁骨下静脉(InfraSCV),近端腋窝静脉(ProxiAV),远端腋窝静脉(DistalAV),和股静脉.
目的:这篇综述旨在比较超声引导下隔膜上方CVC的不同方法的首过成功率和动脉穿刺率。
方法:2023年5月,Embase,MEDLINE,中部,ClinicalTrials.gov,和世界卫生组织国际临床试验平台搜索比较5种CVC方法的随机对照试验(RCT)。使用网络元分析工具中的置信度来评估置信度。13项RCT(4418名参与者和13名比较)纳入本综述。
结果:与其他4种方法相比,SupraSCV方法可能增加了首次尝试成功的比例。SupraSCV首次尝试成功表明风险比(RR)>1.21,较低的95%置信区间(CI)超过1。与IJV相比,SupraSCV方法可能增加了首次尝试成功比例(RR1.22;95%置信区间[CI]1.06-1.40,中等置信度),而DistalAV方法降低了它(RR0.72;95%CI0.59-0.87,高置信度)。动脉穿刺在所有方法中几乎没有差异(低到高置信度)。
结论:考虑到首次尝试成功和机械并发症,SupraSCV可能会成为首选方法,而DistalAV可能是最不可取的方法。然而,应该进行头对头研究,将这些方法与最大的第一次尝试成功进行比较。
Ultrasound-guided central venous catheterization (CVC) has become the standard of care. However, providers use a variety of approaches, encompassing the internal jugular vein (IJV), supraclavicular subclavian vein (SupraSCV), infraclavicular subclavian vein (InfraSCV), proximal axillary vein (ProxiAV), distal axillary vein (DistalAV), and femoral vein.
This review aimed to compare the first-pass success rate and arterial puncture rate for different approaches to ultrasound-guided CVC above the diaphragm.
In May 2023, Embase, MEDLINE, CENTRAL, ClinicalTrials.gov, and World Health Organization International Clinical Trials Platform were searched for randomized controlled trials (RCTs) comparing the 5 CVC approaches. The Confidence in Network Meta-Analysis tool was used to assess confidence. Thirteen RCTs (4418 participants and 13 comparisons) were included in this review.
The SupraSCV approach likely increased the proportion of first-attempt successes compared to the other 4 approaches. The SupraSCV first-attempt success demonstrated risk ratios (RRs) > 1.21 with a lower 95% confidence interval (CI) exceeding 1. Compared to the IJV, the SupraSCV approach likely increased the first-attempt success proportion (RR 1.22; 95% confidence interval [CI] 1.06-1.40, moderate confidence), whereas the DistalAV approach reduced it (RR 0.72; 95% CI 0.59-0.87, high confidence). Artery puncture had little to no difference across all approaches (low to high confidence).
Considering first-attempt success and mechanical complications, the SupraSCV may emerge as the preferred approach, while DistalAV might be the least preferable approach. Nevertheless, head-to-head studies comparing the approaches with the greatest first attempt success should be undertaken.