Key result
Partial withdrawal of the guidewire in the supine position increased the correct rate of catheter tip orientation at first insertion compared to the traditional method.
Why the study?
Catheter tip malposition frequently occurs with subclavian vein catheterization, motivating investigation into the influence of catheter flexibility and position on right subclavian catheter placement.
Does catheter placement in the supine position with a partially retracted guide wire improve the correct rate of catheter tip orientation in children requiring right subclavian vein catheterization?
RCT (n=161)
Open-label
Random number table
No
Does catheter placement in the supine position with a partially retracted guide wire improve the correct rate of catheter tip orientation in children requiring right subclavian vein catheterization?
Using a partially retracted guide wire in the supine position significantly improves correct catheter tip placement and reduces intraoperative arrhythmias during right subclavian vein catheterization in children.
Answers are grounded in this paper and cite their sources.
Supports partial guidewire withdrawal for right subclavian catheterization in children; extends RCT evidence on optimizing first-pass tip orientation.
Background. Catheter tip malposition frequently occurs with subclavian vein catheterization.The supine position returns more and faster blood to the heart than the head down position.It is assumed that the soft catheter is easy to follow the flow forward. This study investigates the influence of catheter flexibility and position on right subclavian catheter placement. Methods. Patients who required subclavian venipuncture catheterization at the Department of Hematology and oncology, Shenzhen Children's hospital were randomly divided into two groups: test group A (80 patients) vs control group B (81 patients).Group A was in the flat position, and the guide wire was partially retracted during catheter placement.Group B used the traditional method of catheterization.Intraoperative ultrasound was used to check the direction of the catheter tip and postoperative chest X-ray was performed. Results. The correct rate of catheter tip orientation at the first insertion in group A was higher than that in group B (86.2% vs 66.7%, P < 0.05), and the rate of catheter misplacement in right internal jugular vein in group A was lower than that in group B (10.0% vs 29.6%, P < 0.05). The incidence of intraoperative arrhythmia in group A was lower than that in group B (0.0% vs 14.8%, P < 0.05).No significant differences in general data and other complications between them. Repeated catheterization failed in 5 patients,and other methods were used for catheterization. Conclusions. The use of the guide wire in the supine position can reduce catheter malposition in children with right subclavian vein catheterization.
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Wang et al. (2023) conducted an RCT in Children requiring elective right subclavian vein catheterization (n=161). Partial drawback of guidewire placement in the supine position vs. Traditional guidewire placement in the head-down position was evaluated on Correct rate of catheter tip orientation at the first insertion (p=0.003). Partial withdrawal of the guidewire in the supine position increased the correct rate of catheter tip orientation at first insertion compared to the traditional method.
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