Benefits and defects of 3 kinds of central vein puncture:analysis of 328 cases

Objective To evaluate the benefits and defects of internal jugular puncture,subclavian vein puncture through the supraclavian approach,and subclavian vein puncture thtough the subclavian approach.Methods 328 patients with different underlying diseases,aged 17~92,underwent central venous puncture,including 158 cases of internal jugular puncture,44 cases of subclavian vein puncture through the supraclavian approach,and 120 cases of subclavian vein puncture thtough the subclavian approach.The success rate and accident morbidity rate of these 3 kinds of puncture were analyzed and compared.Results The success rates of the internal jugular puncture group,subclavian vein puncture through the supraclavian approach group,and subclavian vein puncture thtough the subclavian approach group were 97.5%,97.7%,and 95.2% respectively without significant differences among them(P=0.579)The artery injury rate of the subclavian vein puncture thtough the subclavian approach group was 11.9%,significantly higher than those of the internal jugular puncture group and subclavian vein puncture through the supraclavian approach group(3.2% and 4.5% respectively,P=0.011)The obstruction rate of guide-wire insertion of the subclavian vein puncture thtough the subclavian approach group was 13.5%,significantly higher than of the other 3 groups(2.5% and 2.3% respectively,P=0.001)The failure rate of guide-wire entering the superior vena cava of the subclavian vein puncture thtough the subclavian approach group was 9.5%,significantly higher than of the other 2 groups(3.1% and 0.0% respectively(P=0.017).The hematopneumothorax rate of the subclavian vein puncture thtough the subclavian approach group was 2.3%,significantly higher than those of the other 2 groups(0.6% and 0.0% respectively,P=0.036).Conclusion Internal jugular puncture,subclavian vein puncture through the supraclavian approach,and subclavian vein puncture thtough the subclavian approach are all have a high success rate in central vein puncture.However,being relative safer,Internal jugular puncture and subclavian vein puncture through the supraclavian approach are of first choice.