Faculty of Medicine

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    Landmark versusu ultrasound –guided subclavian central venous cathetirization with a combinated short and long axis approach in an intensive care setting
    (Македонско лекарско друштво = Macedonian Medical Association, 2017)
    Sazdov D
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    Nikolova Todorova Z
    Introduction. Central venous catheterization of the subclavian vein can be achieved with a landmark and an ultrasound-guided method. Using ultrasound the vein can be catheterized with a long axis in plane or a short axis out of plane approach and a combined approach. The aim of the study was to compare the success, average number of attempts and mechanical compli- cation rate between the landmark and the combined ultrasound-guided method. Methods. A total of 162 adult patients from the Intensive Care Unit at Clinical Hospital Acibadem-Sistina, Skopje were included in this prospective study. Patients rando- mized in the examined group (n=71) were catheterized with real-time ultrasound guidance with a combined short axis out of plane and long axis in plane method. Patients randomized in the control group (n=91) were catheterized with the landmark method. Subclavian vein was catheterized in both groups. Overall success, success on first attempt, number of attempts and complications at the moment of catheterization were the main outcome measures. Results. Catheterization using the landmark method was successful in 94.5% of patients, 65.9% of which during the first attempt. Cannulation using real-time ultrasound guidance was successful in all patients with a first pas success of 83.1%. Conclusion. Real-time ultrasound guidance with a combined short axis out of plane and long axis in plane approach improves success, decreases number of attempts, and reduces mechanical complications rate.
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    Scoring System Assessment of Cephalic Vein Access for Device Implantation
    (MediaSphere Medical, LLC, 2018-08)
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    Janusevsi, Filip
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    Pocesta, Bekim
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    Boskov, Vladimir
    The purpose of this study was to explore the usability of the cephalic vein (CV) for cardiac implantable electronic device (CIED) lead access by applying a scoring system to assess the venous anatomy. This prospective, single-center study included 100 consecutive patients who underwent CIED implantation within a period of one year. Contrast-enhanced venography images were obtained for every patient, focused on the CV, “T-junction,” and the subclavian/ axillary veins (SV/AVs). Though careful examination of the images, an angle, valves, diameter, noncollateral (AVDnC) score was constructed and used to aid in choosing a CV or SV/AV access approach; in all cases, however, the preferred approach was CV independent of the AVDnC score result obtained. Upon use of the scoring system, the majority of patients (54%) had type A score result ( 3), indicating a favorable anatomy for CV access. In 48 of these patients, the CV was used for the implantation of at least one lead. The remaining 46 (46%) patients had type B score result ( 2). In 41 patients from this group, SV/AV access was used for lead implantation and, in five patients, CV access was used. The number of leads introduced through the CV was associated with larger score and the operator’s experience. In conclusion, in more than 50% of patients, at least one lead could be introduced through the CV. The scoring system used herein can simplify the choice between CV and SV/AV access and could eventually increase the efficiency and safety of the procedure, especially when less experienced implanters are involved.