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      Comparison of central venous catheter in brachiocephalic vein and internal jugular vein for the incidence of complications in patients undergoing radiology

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          Abstract

          Introduction:

          Central venous catheter (CVC) is an essential part of modern medical care that delivers the drugs, intravenous fluids, and intravenous feeding to the vein. So far, limited studies have been carried out on the brachiocephalic vein (BCV) in adults. This study aimed to compare the CVC in the internal jugular vein (IJV) and BCV in order to ease of access and incidence of complication such as infectious and mechanical complications.

          Materials and Methods:

          This clinical trial was performed on 52 patients who underwent BCV and the IJV catheterization. The patients were compared in two groups of IJV and BCV in order to facilitate catheterization and measure the success rate and catheterization-induced complications. The difference between the two groups was analyzed by Independent t-test and Chi-square tests.

          Results:

          Overall, 52 patients underwent intravenous catheterization. The success rate of catheterization in the first attempt was 100%. The problems of catheterization procedure in the IJV group (11.5%) were greater than the BCV group (6.6%). There was no significant difference between the two groups regarding the duration of catheterization, pneumothorax, emphysema, hematoma, arterial puncture, infection, and complete thrombosis, whereas the partial thrombosis in the IJV group (30.76%) was significantly ( P < 0.05) greater than the BCV group (23.07%).

          Conclusion:

          Catheterization in both brachiocephalic and the IJV is an appropriate, highly efficient, stable, and safe procedure and ultrasound-guided catheterization is very reliable and safe method.

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          Most cited references21

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          Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial.

          B Raffy, J Y Lefrant, J-P Rigaud … (2001)
          Whether venous catheterization at the femoral site is associated with an increased risk of complications compared with that at the subclavian site is debated. To compare mechanical, infectious, and thrombotic complications of femoral and subclavian venous catheterization. Concealed, randomized controlled clinical trial conducted between December 1997 and July 2000 at 8 intensive care units (ICUs) in France. Two hundred eighty-nine adult patients receiving a first central venous catheter. Patients were randomly assigned to undergo central venous catheterization at the femoral site (n = 145) or subclavian site (n = 144). Rate and severity of mechanical, infectious, and thrombotic complications, compared by catheterization site in 289, 270, and 223 patients, respectively. Femoral catheterization was associated with a higher incidence rate of overall infectious complications (19.8% vs 4.5%; P<.001; incidence density of 20 vs 3.7 per 1000 catheter-days) and of major infectious complications (clinical sepsis with or without bloodstream infection, 4.4% vs 1.5%; P =.07; incidence density of 4.5 vs 1.2 per 1000 catheter-days), as well as of overall thrombotic complications (21.5% vs 1.9%; P<.001) and complete thrombosis of the vessel (6% vs 0%; P =.01); rates of overall and major mechanical complications were similar between the 2 groups (17.3% vs 18.8 %; P =.74 and 1.4% vs 2.8%; P =.44, respectively). Risk factors for mechanical complications were duration of insertion (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03-1.08 per additional minute; P<.001); insertion in 2 of the centers (OR, 4.52; 95% CI, 1.81-11.23; P =.001); and insertion during the night (OR, 2.06; 95% CI, 1.04-4.08; P =.03). The only factor associated with infectious complications was femoral catheterization (hazard ratio [HR], 4.83; 95% CI, 1.96-11.93; P<.001); antibiotic administration via the catheter decreased risk of infectious complications (HR, 0.41; 95% CI, 0.18-0.93; P =.03). Femoral catheterization was the only risk factor for thrombotic complications (OR, 14.42; 95% CI, 3.33-62.57; P<.001). Femoral venous catheterization is associated with a greater risk of infectious and thrombotic complications than subclavian catheterization in ICU patients.
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            Complications of central venous catheters: internal jugular versus subclavian access--a systematic review.

            Martin Tramèr, Bernhard Walder, Sibylle Ruesch (2002)
            To test whether complications happen more often with the internal jugular or the subclavian central venous approach. Systematic search (MEDLINE, Cochrane Library, EMBASE, bibliographies) up to June 30, 2000, with no language restriction. Reports on prospective comparisons of internal jugular vs. subclavian catheter insertion, with dichotomous data on complications. No valid randomized trials were found. Seventeen prospective comparative trials with data on 2,085 jugular and 2,428 subclavian catheters were analyzed. Meta-analyses were performed with relative risk (RR) and 95% confidence interval (CI), using fixed and random effects models. In six trials (2,010 catheters), there were significantly more arterial punctures with jugular catheters compared with subclavian (3.0% vs. 0.5%, RR 4.70 [95% CI, 2.05-10.77]). In six trials (1,299 catheters), there were significantly less malpositions with the jugular access (5.3% vs. 9.3%, RR 0.66 [0.44-0.99]). In three trials (707 catheters), the incidence of bloodstream infection was 8.6% with the jugular access and 4.0% with the subclavian access (RR 2.24 [0.62-8.09]). In ten trials (3,420 catheters), the incidence of hemato- or pneumothorax was 1.3% vs. 1.5% (RR 0.76 [0.43--1.33]). In four trials (899), the incidence of vessel occlusion was 0% vs. 1.2% (RR 0.29 [0.07-1.33]). There are more arterial punctures but less catheter malpositions with the internal jugular compared with the subclavian access. There is no evidence of any difference in the incidence of hemato- or pneumothorax and vessel occlusion. Data on bloodstream infection are scarce. These data are from nonrandomized studies; selection bias cannot be ruled out. In terms of risk, the data most likely represent a best case scenario. For rational decision-making, randomized trials are needed.
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              Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization.

              Patrick Brass, Martin Hellmich, Laurentius Kolodziej … (2015)
              Central venous catheters (CVCs) can help with diagnosis and treatment of the critically ill. The catheter may be placed in a large vein in the neck (internal jugular vein), upper chest (subclavian vein) or groin (femoral vein). Whilst this is beneficial overall, inserting the catheter risks arterial puncture and other complications and should be performed with as few attempts as possible. Traditionally, anatomical 'landmarks' on the body surface were used to find the correct place in which to insert catheters, but ultrasound imaging is now available. A Doppler mode is sometimes used to supplement plain 'two-dimensional' ultrasound.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Family Med Prim Care
                Journal ID (iso-abbrev): J Family Med Prim Care
                Journal ID (publisher-id): JFMPC
                Title: Journal of Family Medicine and Primary Care
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 2249-4863
                ISSN (Electronic): 2278-7135
                Publication date Collection: October 2019
                Publication date (Electronic): 31 October 2019
                Volume: 8
                Issue: 10
                Pages: 3379-3382
                Affiliations
                [1 ] Department of Radiology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
                Author notes
                Address for correspondence: Dr. Mohammad M. Gharibvand, Department of Radiology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. E-mail: Mohamad.momen2017@ 123456gmail.com
                Article
                Publisher ID: JFMPC-8-3379
                DOI: 10.4103/jfmpc.jfmpc_205_19
                PMC ID: 6857370
                PubMed ID: 31742172
                SO-VID: 5aaca8cf-bf8f-4fc3-9226-e315ed928099
                Copyright © Copyright: © 2019 Journal of Family Medicine and Primary Care
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 08 March 2019
                Date accepted : 26 March 2019
                Categories
                Subject: Original Article

                Keywords: brachiocephalic vein,catheterization,central vein,internal jugular vein,ultrasound
                Data availability:
                Keywords: brachiocephalic vein, catheterization, central vein, internal jugular vein, ultrasound

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