Hacettepe Üniversitesi Beyin Cerrahi Ameliyathanelerinde Intrakardiyak Elektrokardiyografi Kılavuzluğu ile Yapılan Subklavian Ven Kateterizasyonu Işlemlerinin Retrospektif Değerlendirilmesi

Abstract

Catheterization of a central vein allows anesthesiologists to monitor central venous pressure, manage fluid administration when large shifts are expected and aspiration of venous air embolus from the entrance of right atrium. In our operating rooms right subclavian vein is preferential because it is far from surgical field in neurosurgery patients and easy to reach. Positioning the catheter tip accurately is essential for effective use, measuring central venous pressure exactly and avoiding complications. ECG guidance is a well-known and widely used technique for this purpose. In this retrospective study we reported 1017 catheterization procedures to summarize the complications of subclavian vein catheterization and the effectiveness of intracardiac electrocardiographic guidance for positioning the catheter tip acurrately. After gaining Hacettepe University Non-Interventional Researches Ethics Commitee approval, subclavian vein cannulations done in three operating rooms over the period of 9 years (January 2004 to October 2013) were retrospectively evaluated for side of insertion, number of attempts of puncture, arterial puncture as well as the malpositions and mechanical complications on the records of post procedural chest X-ray. The records were also evaluated for the experience of the operator performing cannulation and relationship between experience of operator to complications and malpositions of catheter. Chi-square test was applied to evaluate the statistical significance. P < 0.05 was significant. Over nine years period 1364 subclavian vein catheterizations were performed. 178 of patients under age of 18. 69 of them were not evaluated because of incomplete records. 1017 catheterizations were evaluated. 962 catheterizations were performed with endovascular electrocardiographic guidence. 52 complications in 50 patients were recorded. The overall complication rate is 4,91%. Pneumothorax was recorded in 1 patient (0,09 %) and in 5 (0,5%) patients arterial puncture was v recorded. Malpositions were recorded in 6 patients (0,58%) and in 5 of them intracardiac electrocardiogram was used. In 957 patients catheter tip is located in the entrance of right atrium. In 109 catheterizations arrhythmia was unseen. The percent of males that have no arrhythmias was statistically significant from females (53%, 47% respectively; p=0,037). Arithmetic mean of number of punctures between fellows and residents are 1, 19±0,52 and 1, 20±0,55 respectively. The difference between the numbers is not statistically significant (p=0,674). There is statistical significance between fellows and residents who left catheterization to a more experienced anesthesiologist (p=0,007). In this study endovascular electrocardiogram is found effective for accurate positioning of catheter tip in subclavian vein catheterization. According to this study and data from literature the most procedural complication of subclavian vein catheterization is arterial puncture. Number of puncture attempts and complications are independent from the experience of performer. The more the anesthesiologists’ experience is the need to leave the catheterization to a more experienced one decreases. Difference of arrhythmia between males and females is probably depends on the difference of heights between genders. The complication rate is similar between genders.