Single-plane versus real-time biplane approaches for ultrasound-guided central venous catheterization in critical care patients: a randomized controlled trial

Li, YY; Liu, YH; Yan, L; Xiao, J; Li, XY; Ma, J; Jia, LG; Chen, R; Zhang, C; Yang, Z; Zhang, MB; Luo, YK

doi:10.1186/s13054-023-04635-y

ICU sedation, delirium & recovery

Single-plane versus real-time biplane approaches for ultrasound-guided central venous catheterization in critical care patients: a randomized controlled trial

Crit CarePublished 23 Sep 2023Randomised controlled trial

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Authors' conclusion

Real-time biplane imaging of ultrasound-guided CVCs offers advantages over the single-plane approach for critically ill patients.

Study context

Population: Critically ill patients requiring central venous cannulation182 internal jugular vein cannulation (IJVC), 74 femoral vein cannulation (FVC)
Participants: 256 patients

Comparison: Real-time biplane vs single-plane ultrasound-guided central venous cannulation (CVC)
Biplanen = 128
Single-planen = 128reference
Primary endpoint: Successful puncture on the first attempt

Methodological detailsprospective, October 2022 to March 2023

Prospective
October 2022 to March 2023

Primary result

As reported in the abstract

First-attempt puncture success

Biplane91.6%

Single-plane74.7%

Biplane vs Single-planeRR for first-attempt puncture success (95% CI)P value

IJVC

1.226(1.069–1.405)

P = 0.002

FVC; 90.9% vs. 68.3%

1.331(1.053–1.684)

P = 0.019

Further findings

First-puncture single-pass catheterization success

IJVC, Biplane vs Single-plane: 87.4% vs. 69.0%
FVC, Biplane vs Single-plane: 90.9% vs. 68.3%

All P < 0.05

Number of undesired punctures

IJVC, Biplane vs Single-plane: 1[1-1(1-2)] vs. 1[1-2(1-4)]
FVC, Biplane vs Single-plane: 1[1-1(1-3)] vs. 1[1-2(1-4)]

Fewer with biplane
All P < 0.05

Cannulation time

IJVC, Biplane vs Single-plane: 205 s [162-283 (66-1,526)] vs. 311 s [243-401 (136-1,223)]
FVC, Biplane vs Single-plane: 228 s [193-306 (66-1,669)] vs. 340 s [246-499 (130-944)]

Shorter with biplane
All P < 0.05

Safety

Immediate complications

IJVC, Biplane vs Single-plane: 10.5% vs. 28.7%
FVC, Biplane vs Single-plane: 9.1% vs. 34.1%

All P < 0.05

Original publication

Single-plane versus real-time biplane approaches for ultrasound-guided central venous catheterization in critical care patients: a randomized controlled trial. Crit Care. Published 23 September 2023. doi:10.1186/s13054-023-04635-y

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