Introduction of ultrasound-guided axillary vein approach for central venous catheterization in severely injured trauma patients: characteristics and concerns
BackgroundThe ultrasound-guided axillary vein approach for central venous catheterization (UAVC) demonstrates high success rates and low complications; however, its utilization in trauma care settings remains limited. This study aimed to characterize UAVC practices in a trauma intensive care unit (T...
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Frontiers Media S.A.
2025-08-01
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| author | Ruonan Gu Ruonan Gu Ruonan Gu Ruonan Gu Shanxiang Xu Shanxiang Xu Shanxiang Xu Shanxiang Xu Shouyin Jiang Shouyin Jiang Shouyin Jiang Shouyin Jiang Xiao Lu Xiao Lu Xiao Lu Xiao Lu Haizhen Wang Haizhen Wang Haizhen Wang Haizhen Wang Xiaogang Zhao Xiaogang Zhao Xiaogang Zhao Xiaogang Zhao |
| author_facet | Ruonan Gu Ruonan Gu Ruonan Gu Ruonan Gu Shanxiang Xu Shanxiang Xu Shanxiang Xu Shanxiang Xu Shouyin Jiang Shouyin Jiang Shouyin Jiang Shouyin Jiang Xiao Lu Xiao Lu Xiao Lu Xiao Lu Haizhen Wang Haizhen Wang Haizhen Wang Haizhen Wang Xiaogang Zhao Xiaogang Zhao Xiaogang Zhao Xiaogang Zhao |
| author_sort | Ruonan Gu |
| collection | DOAJ |
| description | BackgroundThe ultrasound-guided axillary vein approach for central venous catheterization (UAVC) demonstrates high success rates and low complications; however, its utilization in trauma care settings remains limited. This study aimed to characterize UAVC practices in a trauma intensive care unit (TICU) at a tertiary teaching hospital, specifically investigating optimal catheter positioning, procedure-related complications, and risk factors associated with catheter inaccurate placement and venous thromboembolism (VTE) development.MethodsA retrospective analysis was performed on trauma patients who underwent UAVC between October 2021 and April 2023. This analysis was based on electronic medical records. Details of patients, procedures, and instances of catheter misplacement were carefully documented. The immediate complications after UAVC, including pneumothorax, hemothorax, hematoma, arteriovenous fistula, arterial dissection, and skin infection, were recorded. Moreover, late-onset complications such as VTE and catheter-related bloodstream infections (CRBSI) were also noted. Logistic regression was utilized to determine the independent risk factors for non-optimal catheter tip placement and VTE.ResultsA total of 132 UAVC cases were analyzed, with 113 (85.6%) performed by resident physicians and no immediate complications observed. The VTE incidence was 27.3%, particularly higher in elderly patients (≥ 65 years, 43.4%), and fever during TICU stay was noted in 55.3% of cases. Catheter-related infections occurred at a rate of 3.38 per 1,000 catheter days, with eight cases (6.06%) of catheter misplacement. Accurate placement was achieved in 29.8% of 121 patients, predominantly on the right side (40.4%). Factors influencing inaccurate placement included patient age [odds ratios (OR) 1.06, 95% confidence interval (CI) 1.02–1.10], obesity (OR 9.31, 95% CI 2.58–33.56), and left-side placement (OR 133.04, 95% CI 21.66–817.29), while patient age (>54 years), fever, and ventilation duration (>6.6 days) were associated with VTE development.ConclusionIn severely injured trauma patients, UAVC is associated with a high incidence of VTE and a low rate of optimal catheter tip positioning. Our findings underscore the necessity of standardized protocols to refine catheter tip placement and warrant further investigation through randomized controlled trials. |
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| spelling | doaj-art-5960e2f0c7a74d8ba6eaf32bbfb96d312025-08-20T03:44:06ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-08-011210.3389/fmed.2025.16037781603778Introduction of ultrasound-guided axillary vein approach for central venous catheterization in severely injured trauma patients: characteristics and concernsRuonan Gu0Ruonan Gu1Ruonan Gu2Ruonan Gu3Shanxiang Xu4Shanxiang Xu5Shanxiang Xu6Shanxiang Xu7Shouyin Jiang8Shouyin Jiang9Shouyin Jiang10Shouyin Jiang11Xiao Lu12Xiao Lu13Xiao Lu14Xiao Lu15Haizhen Wang16Haizhen Wang17Haizhen Wang18Haizhen Wang19Xiaogang Zhao20Xiaogang Zhao21Xiaogang Zhao22Xiaogang Zhao23Department of Emergency Medicine, Haiyan People’s Hospital, Haiyan, Zhejiang, ChinaZhejiang Key Laboratory of Trauma, Burn, and Medical Rescue, Hangzhou, ChinaZhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, ChinaResearch Institute of Emergency Medicine, Zhejiang University, Hangzhou, ChinaZhejiang Key Laboratory of Trauma, Burn, and Medical Rescue, Hangzhou, ChinaZhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, ChinaResearch Institute of Emergency Medicine, Zhejiang University, Hangzhou, ChinaDepartment of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, ChinaZhejiang Key Laboratory of Trauma, Burn, and Medical Rescue, Hangzhou, ChinaZhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, ChinaResearch Institute of Emergency Medicine, Zhejiang University, Hangzhou, ChinaDepartment of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, ChinaZhejiang Key Laboratory of Trauma, Burn, and Medical Rescue, Hangzhou, ChinaZhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, ChinaResearch Institute of Emergency Medicine, Zhejiang University, Hangzhou, ChinaDepartment of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, ChinaZhejiang Key Laboratory of Trauma, Burn, and Medical Rescue, Hangzhou, ChinaZhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, ChinaResearch Institute of Emergency Medicine, Zhejiang University, Hangzhou, ChinaDepartment of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, ChinaZhejiang Key Laboratory of Trauma, Burn, and Medical Rescue, Hangzhou, ChinaZhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, ChinaResearch Institute of Emergency Medicine, Zhejiang University, Hangzhou, ChinaDepartment of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, ChinaBackgroundThe ultrasound-guided axillary vein approach for central venous catheterization (UAVC) demonstrates high success rates and low complications; however, its utilization in trauma care settings remains limited. This study aimed to characterize UAVC practices in a trauma intensive care unit (TICU) at a tertiary teaching hospital, specifically investigating optimal catheter positioning, procedure-related complications, and risk factors associated with catheter inaccurate placement and venous thromboembolism (VTE) development.MethodsA retrospective analysis was performed on trauma patients who underwent UAVC between October 2021 and April 2023. This analysis was based on electronic medical records. Details of patients, procedures, and instances of catheter misplacement were carefully documented. The immediate complications after UAVC, including pneumothorax, hemothorax, hematoma, arteriovenous fistula, arterial dissection, and skin infection, were recorded. Moreover, late-onset complications such as VTE and catheter-related bloodstream infections (CRBSI) were also noted. Logistic regression was utilized to determine the independent risk factors for non-optimal catheter tip placement and VTE.ResultsA total of 132 UAVC cases were analyzed, with 113 (85.6%) performed by resident physicians and no immediate complications observed. The VTE incidence was 27.3%, particularly higher in elderly patients (≥ 65 years, 43.4%), and fever during TICU stay was noted in 55.3% of cases. Catheter-related infections occurred at a rate of 3.38 per 1,000 catheter days, with eight cases (6.06%) of catheter misplacement. Accurate placement was achieved in 29.8% of 121 patients, predominantly on the right side (40.4%). Factors influencing inaccurate placement included patient age [odds ratios (OR) 1.06, 95% confidence interval (CI) 1.02–1.10], obesity (OR 9.31, 95% CI 2.58–33.56), and left-side placement (OR 133.04, 95% CI 21.66–817.29), while patient age (>54 years), fever, and ventilation duration (>6.6 days) were associated with VTE development.ConclusionIn severely injured trauma patients, UAVC is associated with a high incidence of VTE and a low rate of optimal catheter tip positioning. Our findings underscore the necessity of standardized protocols to refine catheter tip placement and warrant further investigation through randomized controlled trials.https://www.frontiersin.org/articles/10.3389/fmed.2025.1603778/fullaxillary veincentral venous catheterizationvenous thromboembolismmultiple traumaultrasound |
| spellingShingle | Ruonan Gu Ruonan Gu Ruonan Gu Ruonan Gu Shanxiang Xu Shanxiang Xu Shanxiang Xu Shanxiang Xu Shouyin Jiang Shouyin Jiang Shouyin Jiang Shouyin Jiang Xiao Lu Xiao Lu Xiao Lu Xiao Lu Haizhen Wang Haizhen Wang Haizhen Wang Haizhen Wang Xiaogang Zhao Xiaogang Zhao Xiaogang Zhao Xiaogang Zhao Introduction of ultrasound-guided axillary vein approach for central venous catheterization in severely injured trauma patients: characteristics and concerns Frontiers in Medicine axillary vein central venous catheterization venous thromboembolism multiple trauma ultrasound |
| title | Introduction of ultrasound-guided axillary vein approach for central venous catheterization in severely injured trauma patients: characteristics and concerns |
| title_full | Introduction of ultrasound-guided axillary vein approach for central venous catheterization in severely injured trauma patients: characteristics and concerns |
| title_fullStr | Introduction of ultrasound-guided axillary vein approach for central venous catheterization in severely injured trauma patients: characteristics and concerns |
| title_full_unstemmed | Introduction of ultrasound-guided axillary vein approach for central venous catheterization in severely injured trauma patients: characteristics and concerns |
| title_short | Introduction of ultrasound-guided axillary vein approach for central venous catheterization in severely injured trauma patients: characteristics and concerns |
| title_sort | introduction of ultrasound guided axillary vein approach for central venous catheterization in severely injured trauma patients characteristics and concerns |
| topic | axillary vein central venous catheterization venous thromboembolism multiple trauma ultrasound |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1603778/full |
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