Ibrahim Ibrahim Abd El BASER, Nabil Abdelraouf ABDELMAGEED, Mohamed EL-MORSY

Ultrasound-Guided Infraclavicular Axillary Vein Cannulation: - Is it a Good Alternative to Internal Jugular Vein Cannulation in Pediatric Cardiac Surgery?

Objective: This study was designed to compare the rates of successful first attempt and mechanical complications between internal jugular vein (IJV) and axillary vein (AXV) cannulation.Methods: This prospective, randomized, comparative, controlled study included 220 pediatricpatients with age range 1 to 12 years scheduled for cardiac surgery. Patients were allocated into2 equal groups as IJV and AXV groups. The rates of successful first, second and third punctureattempts and the mechanical complications (arterial puncture, pneumothorax, catheter occlusion, catheter malposition, nerve injury) were investigated.Results: There was no statistically significant difference (p=0.053) in the first skin puncture success rates in both groups (AXV group 80% and IJV group 68%). There were no significant differences regarding the second and third skin puncture success rates. The incidence rates of failedvein punctures were similar in IJV (3%) and AXV (2%) groups. The vein puncture and catheterinsertion times and the rates. Arterial puncture, pneumothorax and catheter malposition weresimilar in IJV and AXV groups (12% vs 11%, 4% vs 1%, 3% vs 5% respectively). The rates of catheter occlusion with sternal retraction were significantly higher (p=0.029) in AXV than IJV group(6% vs 0%). Postoperative phrenic (IJV group) or brachial plexus nerve injury (AXV group) was notdeveloped in any patient.Conclusion: Ultrasound-guided cannulation of both infraclavicular AXV and IJV were similarlyassociated with high success rates and low incidence of mechanical complications.

Ultrasonografi Kılavuzluğunda İnfraklaviküler Aksiller Ven Kanülasyonu: - Pediyatrik Kalp Cerrahisinde İnternal Juguler Vene İyi Bir Alternatif midir?

Amaç: Bu çalışma, internal juguler ven (IJV) ve aksiller ven (AXV) kanülasyonu arasındaki başarılı ilk girişim ve mekanik komplikasyon oranlarını karşılaştırmak için tasarlanmıştır. Yöntem: Bu prospektif, randomize, karşılaştırmalı, kontrollü çalışma, kalp cerrahisi yapılacak olan 1-12 yaş aralığında 220 pediyatrik hastada yapıldı. Hastalar, IJV grubu ve AXV grubu olmak üzere 2 eşit gruba ayrıldı. Başarılı birinci, ikinci ve üçüncü ponksiyon girişimlerinin ve mekanik komplikasyonların (arteriyel ponksiyon, pnömotoraks, kateter tıkanması, yanlış kateter pozisyonu, sinir yaralanması) sıklığı araştırıldı. Bulgular: Her iki grubun ilk girişimindeki başarı oranında istatistiksel olarak anlamlı bir fark yoktu (p=0.053) (AXV grubunda %80 ve IJV grubunda %68). İkinci ve üçüncü girişimdeki başarı oranları arasında da fark bulunmadı. IJV (%3) ve AXV (%2) gruplarının başarısız ven ponksiyonu insidansları da benzerdi (p=1.000). Yine IJV ve AXV gruplarının ven ponksiyonu ve kateter yerleştirme süreleri ile arteriyel ponksiyon, pnömotoraks ve kateter malpozisyonu oranları benzerdi (sırasıyla %12’ye karşı %11, %4’e karşı %1, %3’e karşı %5). Sternum retraksiyonu ile kateter oklüzyonu, AXV grubun’da IJV grubundan (%6’ya karşı %0) anlamlı şekilde daha yüksekti (p=0.029). Hiçbir hastada postoperatif frenik sinir (IJV grubu) veya brakiyal pleksus sinir hasarı (AXV grubu) gelişmedi. Sonuç: Hem infraklaviküler AXV hem de IJV’nin ultrasonografi kılavuzluğunda kanülasyonu yüksek başarı oranı ve düşük mekanik komplikasyon insidansı ile ilişkilidir

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