Discussion
MCSL, puncture failure
REGRESSION, COMPLICATIONS
In this randomized controlled clinical trial comparing two ultrasound-guided Technologies (MCSL and OA-IP) for right IJVC, we found that MCSL was noninferior to OA-IP in the first needle pass without PVWP, and was associated with less procedure time and fewer mechanical complications compared with OA-IP. Our data suggest that these two ultrasound-guided methods are equally effective in adult patients undergoing right IJVC.OA-IP has been increasingly recommended in recent years for performing ultrasound-guided IJVC [In our study, OA-IP approach exhibited a higher incidence of PVWP compared to prior studies [MCSL combines the strengths of the short-axis combined long-axis method and the modified short axis out of plane approach, and is currently a new method that has not been fully studied [The shorter guidewire insertion time and total cannulation time observed in the MCSL group in our study may be attributed to the operator’s discomfort operation posture while performing IJVC using the OA-IP technique. Furthermore, the OA-IP method necessitates additional time during the CVC procedure to prevent inadvertent puncture of the nearby EJV. In our research, 3 failed cases were found in the MCSL group. We considered that the main reason for puncture failure was that the ultrasound shadows was blurred and the puncture point cannot be accurately located. Future research aimed at improving the imaging quality of the ultrasound shadows may further enhance the puncture success rate.Through logistic regression analysis, we found that IJV longitudinal diameter and CCA transverse diameter were closely related to the first needle pass without PVWP. It’s common sense that more collapsed the blood vessel, the smaller of the puncture space, which certainly lead to the more difficult on puncture and the greater possibility of the posterior wall puncture. In addition, the IJV longitudinal diameter is the only one of these three factors that we can intervene on. What factors affect the IJV longitudinal diameter and how to increase it requires further analysis and research. The mechanism behind the increased success rate of puncture with an increased carotid artery diameter is currently unknown and requires further analysis.Our study has some limitations. There was only one operator in this study, and differences in his proficiency with the two procedures may influence the results of the trial. We only included adult patients for right internal jugular vein puncture, and it must be cautious to extrapolate to children and left internal jugular vein. Future studies, including novice operators, involving pediatric populations and the left internal jugular vein, are essential to certify our findings.