속목정맥 중심정맥관 삽입과 합병증의 확인을 위한 초음파 지침의 유용성: Sonographic Assessment of the Venous Excavation (SAVE) Protocol

Abstract

Purpose: Central venous catheterization (CVC) playsimportant roles in treatment of critically ill patients. Althoughuse of ultrasound has led to a decrease in CVC related complications,adverse events still occur. Therefore, we usuallycheck the chest x-ray for confirmation. The purpose of thisstudy was to evaluate the usefulness of point of care ultrasoundduring catheterization of the internal jugular vein (IJV). Methods: The authors conducted a prospective study ofemergency department (ED) patients undergoing CVC viaIJV. Among the enrolled patients, 97 underwent SAVE,which consisted of 1) pre-CVC lung ultrasound, 2) ultrasoundguided puncture of central vein, 3) sonographicdetection of the guide wire before dilation, and 4) post-CVClung ultrasonography. The primary outcome was the successrate of each stage. The secondary outcome was anestimated time of the SAVE exam. The entire process ofpatients’ care was recorded by video for the purpose of timeanalysis. Physicians described anatomical site, reason forcatheterization, and acute mechanical complications. Results: In all subjects, the guide wire was visible withinthe lumen of the IJV. Median access time, from insertion todetection of the guide wire in IJV via ultrasound, was 20seconds. After the CVC was inserted, post-CVC lung ultrasonographywas completed within a median time of 68 seconds. Identification of the chest x-ray image took more than5 minutes. Acute mechanical complications - whichoccurred in three patients - were detected immediately bySAVE. Conclusion: SAVE may provide greater safety during CVCby detection of CVC related complication more properly,without delay.