• Jun Takeshita, Kei Nishiyama, Atsushi Fukumoto, and Nobuaki Shime.
• Department of Intensive Care Medicine, Osaka Prefectural Hospital Organization, Osaka Women's and Children's Hospital, Izumi, Osaka Japan. Electronic address: t-k-s-t@koto.kpu-m.ac.jp.
• J. Cardiothorac. Vasc. Anesth. 2019 Apr 1; 33 (4): 1029-1034.

ObjectiveVisualizing the needle tip using the short-axis out-of-plane (SA-OOP) ultrasound-guided central venous catheterization approach is difficult and results in posterior wall puncture (PWP). To improve needle tip visualization in the long-axis view, combining the SA-OOP and the long-axis in-plane approaches has been suggested. The authors, who previously reported on the utility of this technique using a manikin model, examined the feasibility of this novel method (referred to as the combined short-axis and long-axis [CSLA] approach) and compared the CSLA approach with the SA-OOP approach in humans for the present study.DesignProspective observational study.SettingSingle institution, Rakuwakai Otowa Hospital.ParticipantsPatients undergoing cardiac or vascular surgeries.InterventionsThe CSLA and SA-OOP approaches were used for ultrasound-guided right jugular venous puncture. The puncturing procedures were determined arbitrarily preoperatively without consideration of the patient's neck anatomy and were based on the operator's preference without randomization.Measurements And Main ResultsThe study comprised 100 patients. Successful guidewire insertion without PWP was performed in 48 patients (96%) in the CSLA approach group and 33 (66%) in the SA-OOP approach group; the rate was significantly higher in the CSLA approach group (p = 0.0001). The procedural durations were 27.5 (range 17.0-122.0) seconds in the CSLA approach group and 25.0 (range 15.0-158.0) seconds in the SA-OOP approach group (p = 0.19).ConclusionsThis study showed that the CSLA approach to ultrasound-guided central venous catheterization might help prevent PWP.Copyright © 2018 Elsevier Inc. All rights reserved.

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