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Korean J Crit Care Med > Volume 28(4); 2013 > Article
Korean Journal of Critical Care Medicine 2013;28(4): 280-286. doi: https://doi.org/10.4266/kjccm.2013.28.4.280
중심정맥도관삽입술 시 위치이상의 빈도를 감소시키는 방법: 실시간 초음파 유도하 재위치
안홍준⋅김건동⋅조별님희⋅정원준⋅유연호⋅유 승⋅이진웅⋅김승환⋅유인술⋅조용철
충남대학교 의과대학 충남대학교병원 응급의학과
How to Decrease the Malposition Rate of Central Venous Catheterization: Real-Time Ultrasound-Guided Reposition
Hongjoon Ahn, Gundong Kim, Byulnimhee Cho, Wonjoon Jeong, Yeonho You, Seung Ryu, Jinwoong Lee, Seungwhan Kim, Insool Yoo, Yongchul Cho
Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea. boxter73@cnuh.co.kr
BACKGROUND: The purpose of this retrospective and prospective study is to evaluate the efficiency of ultrasound (US) guidance as a method of decreasing the malposition rate of central venous catheterization (CVC) in the emergency department (ED). METHODS: We retrospectively enrolled 379 patients who underwent landmark-guided CVC (Group A) and prospectively enrolled 411 patients who underwent US-guided CVC (Group B) in the ED of a tertiary hospital. Malposition of the CVC tip is identified when the tip is not located in the superior vena cava (SVC). In Group B, we performed US-guided intravascular guide-wire repositioning and then confirmed the location of the CVC tip with chest radiography when the guide-wire was visible in any three other vessels rather than in the approached vessel. In the case of a guide-wire inserted into the right subclavian vein (SCV), the left SCV and both internal jugular veins (IJV) were referred to as the three other vessels. The two subject groups were compared in terms of the malposition rate using Fisher's exact test (significance = p < 0.05). RESULTS: There were 38 malposition cases out of a total of 790 CVCs. The malposition rates of Groups A and B were 5.5% (21) and 4.1% (17), respectively, and no statistically significant difference in malposition rate between the two groups was found. In Group B, the malposition rate was decreased from 4.1% (17) to 1.2% (5) after the guide-wire was repositioned with US guidance, which led to a statistically significant difference in malposition rate (p < 0.01). CONCLUSIONS: The authors concluded that repositioning the guide-wire with US guidance increased correct placement of central venous catheters toward the SVC.
Key Words: central venous catheterization; complication; emergency department; malposition; ultrasound
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