Comparing Short-, Long-, and Oblique-Axis Approaches to Ultrasound-Guided Internal Jugular Venous Catheterization: A Meta-Analysis of Randomized Controlled Trials

Background Internal jugular venous catheterization (IJVC) is performed for numerous therapeutic interventions. Although ultrasound-guided IJVC is the gold standard for this procedure, complications can still occur. Various scanning axes, namely the short axis (SA), long axis (LA), and oblique axis (OA), have been developed to ameliorate these complications. This study compared the efficacy and safety of SA, LA, and OA approaches. Methods PubMed, Embase, and Cochrane Library databases were searched for studies published before September 2018. Only randomized controlled trials (RCTs) were included. We conducted meta-analyses using a random effects model. Treatment efficacy was measured by total success rate, first pass success rate, number of needle passes, and incidence of complications, namely arterial puncture, hematoma and catheter-related bloodstream infection (CRBSI). Results Six RCTs with 621 patients were included. No significant differences were observed in total success rate and first pass success rate, as well as in the arterial puncture, hematoma, or CRBSI complications between SA and LA approaches. Moreover, no significant difference was found between SA and OA approaches in terms of total success rate, first pass success rate, number of needle passes, and complications of arterial puncture and hematoma. However, number of needle passes was significantly fewer in SA approach than in LA approach (weighted mean difference: −0.18; 95% confidence interval: −0.35, −0.01). Conclusions None of the scanning axes exhibited unique features that could enhance their suitability for application. Hence, scanning axes should be selected by considering various factors that include patient characteristics, clinician expertise, and ease of procedures. Level of evidence Systematic review and meta-analysis, level I. Address correspondence and reprint requests to: Center for Evidence-based Health Care, Taipei Medical University-Shuang Ho Hospital, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan. Tel: 886-2-22490088 ext.8860. Fax: 886-2-22490088 ext.2507. E-mail: kelvintam@h.tmu.edu.tw (Ka-Wai Tam). E-mail: b101099094@tmu.edu.tw (Chih-Heng Chen) Ka-Wai Tam and Chih-Heng Chen contributed equally to this work. Author Disclosure: The authors have no conflicts of interest or financial ties to disclose. Funding: This work was supported by a research grant from Chi Mei Medical Center and Taipei Medical University (grant No.: 106CM-TMU-14). The sponsoring organization was not involved in the study design, data analysis, or interpretation. Contributions: Chih-Heng Chen and Ka-Wai Tam devised and designed the study. Jen-Yin Chen, Chih-Heng Chen and Ka-Wai Tam extracted data; Jen-Yin Chen, Li-Kai Wang, Yao-Tsung Lin, Kuo-Mao Lan, Chih-Heng Chen and Ka-Wai Tam analyzed and interpreted data; El-Wui Loh, Chih-Heng Chen and Ka-Wai Tam wrote the first draft; all authors contributed to subsequent versions and approved the final article; Chih-Heng Chen and Ka-Wai Tam are the guarantors. Acknowledgement We acknowledge Wallace Academic Editing for editing this manuscript. © 2018 Lippincott Williams & Wilkins, Inc.

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