원저 : 응급의료센터에서 초음파를 이용한 속목정맥 카테터삽입법: 1인 초음파 유도 삽입법, 2인 초음파 유도 삽입법과 해부학적 지표 의존 삽입법의 비교

Purpose: The purpose of this study was to determine whether ultrasonography assisted internal jugular central venous catheterization by single operator or two-operator could improve the success rate and decrease the number of complications compared to the traditional landmark technique. Methods: This study was a prospective, randomized, clinical trial conducted from July 2008 to February 2009 in an urban Korean teaching hospital. Patients requiring central venous access were randomized to 1 of the 3 insertion techniques (single-operator technique, two-operator technique, traditional landmark technique). The primary outcome measure was cannulation success. Additional outcome measures included number of attempts, access times, and complications. Results: One hundred fourteen patients were enrolled. Thirty four of 37(91.9%) internal jugular vein catheters were successfully inserted by single-operator technique, 34 of 39(87.2%) by two-operator technique and 22 of 38(57.9%) by landmark technique. First attempt cannulation was successful in 28 of 34(82.4%) using single-operator technique, 26 of 34(76.9%) using two-operator technique and 9 of 22(40.9%) using landmark technique. The median start to venipuncture time was 138 seconds by single-operator technique, 170 seconds by two-operator technique and 329 seconds by landmark technique. There were 19 complications in the study, 15 in the landmark group, 2 in the singleoperator group, and 2 in the two-operator group. Conclusion: Real-time ultrasonography assisted internal jugular vein catheterization has an higher success rate, is less time consuming, and has a lower complication rate. The single-operator technique appears to be equivalent to the two-operator technique in success rate and procedure time.