ObjectiveTo systematically review the effectiveness and safety of anatomic landmarks positioning method (ALM) and real-time two-dimensional ultrasound (RTUS) guidance in the internal jugular vein cannulation. MethodsWe searched PubMed, EMbase, Web of Knowledge, CBM, WanFang Data and CNKI for randomized controlled trials (RCTs) concerning the effectiveness and safety of ALM and RTUS in the internal jugular vein catheterization up to May 1st, 2014. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assess methodological quality of included studies. Then meta-analysis was performed using RevMan 5.3 software. ResultsA total of 10 RCTs involving 1 973 cases were included in the metaanalysis. The results of meta-analysis showed that, compared with the ALM method, the RTUS method reduced puncture failure rate (OR=0.08, 95%CI 0.05 to 0.15, P<0.000 01). For safety, compared with the ALM method, the RTUS method was significantly lower in arterial injury rate (peto-OR=0.22, 95%CI 0.14 to 0.37, P<0.000 01), and the incidence of pneumothorax (peto-OR=0.13, 95%CI 0.04 to 0.40, P=0.000 3). ConclusionCompared to the ALM method, the RTUS method has characteristics such as causing fewer traumas, and having higher success rate and fewer complications. Due to limited quantity and quality of the included studies, the above conclusion still needs to be verified by conducting more studies.
ObjectiveTo evaluate the ultrasonic pre locating internal jugular venous cannulation in infants, comparison with the external landmark technique.MethodsSixty two infants scheduled for cardiac surgery were randomized prospectively into two groups. In the anatomic landmarks group( n =30), the patient’s internal jugular vein(IJV) were cannulated by using the traditional method of palpation of carotid pulsation and identification of other anatomic landmarks. In the ultrasonic pre locating group ( n =32), an two dimensional ultrasound scanner image made for locating the puncture site of vessels was used with an operative probe of HP SONOS 4500 system. The number of attempts, success rate, and incidence of complications were compared for two groups.ResultsThe success rate was 100% vs 80% in the ultrasonic pre locating group vs anatomic landmarks group, with a 3.1% vs 26 7% incidence of carotid artery punctures and the number of attempts 1.57±1.04 vs 2.55±1.76. All differences were statistically significant ( P lt;0.05,0.05,0.01). Conclusion Ultrasonographic pre-localization of the IJV is superior to the anatomic landmarks technique in terms of overall success , and decreases incidence of carotid artery puncture.
ObjectiveTo explore the key points, indications and safety of trans-jugular transcatheter closure of atrial septal defect (ASD) in infants.MethodsThe clinical data of 53 infants with ASD from January 2017 to May 2019 in our hospital were retrospectively reviewed. There were 20 males and 33 females with the age of 1.2 (0.5-2.9) years, and body weight of 9.0 (6.8-10.6) kg. The ASD diameter was 9.8 (8.0-14.0) mm. Thirty-one patients were treated under the guidance of transesophageal ultrasound (TEE), and the other 22 patients under the guidance of transthoracic echocardiography (TTE). We used the steerable curved sheath through the internal jugular vein under the guidance of echocardiography, and the average occluder size was 13.5±4.5 mm.ResultsAll of the 53 patients were successfully occluded, and none of them changed to radiation-guided or transthoracic surgery. Postoperative hospital stay was 3.35±0.70 d. There was no complication such as peripheral vascular injury, occluder malposition or displacement, serious arrhythmia or pericardial effusion. The patients were followed up for 14.3±5.1 months without arrhythmia, residual shunt, occluder malposition or displacement or thrombus.ConclusionEchocardiography-guided trans-jugular closure of ASD for infants with low weight and large ASD shunt or patients with inferior vena cava abnormalities not suitable for femoral vein treatment, not only overcomes the radiation risk of radiation guidance, but also maintains the advantages of minimal invasiveness and safety, providing a new treatment option for such patients.
ObjectiveTo systematically evaluate the efficacy and safety of anatomical landmark method (ALM) versus ultrasound (US)-guided internal jugular vein (IJV) catheterization in pediatric patients. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 10, 2016), CNKI, CBM, WanFang Data and CNKI were searched from inception to October 2016 to collect randomized controlled trials (RCTs) of landmark-guided versus ultrasound-guided IJV catheterization in pediatric patients who underwent elective surgery. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then RevMan 5.3 software was used to perform meta-analysis. ResultsA total of 13 RCTs involving 1 026 pediatric patients were included. The results of meta-analysis showed that, the overall success rate (RR=1.21, 95%CI 1.09 to 1.34, P=0.000 5) and arterial puncture rate (RR=0.19, 95%CI 0.07 to 0.50, P=0.000 7) of US-guided IJV catheterization were both significantly superior to the ALM group. Whereas there was no significant difference between two groups as for the incidence of hematoma formation (RR=0.35, 95%CI 0.09 to 1.31, P=0.12). ConclusionCurrent evidence shows that, for IJV catheterization of pediatric patients, both the effectiveness and safety of ultrasound-guided technique are better than the landmark-guided. Since the quantity and quality of included studies are limited, the conclusion of this study needs more high quality studies to verify.
We reported a 54-year-old female patient with severe tricuspid regurgitation, who received mechanic valve in the mitral position 15 years ago. The patient’s Society of Thoracic Surgeons score was 8.27%, and was intolerant to open heart surgery, so she was recommended for transcatheter tricuspid valve replacement via right vena jugularis interna. The procedures were guided by echocardiography and X ray fluoroscopy on November 13, 2021, the prosthesis was implanted successfully, and the patient was recoved without any adverse events. After 1 month follow-up, her general condition was apparently improved.