Tuesday November 21, 2006
Ultrasound guided central venous catheterization.

All new studies point towards the fact that bedside ultrasound guided venous catheter placement would be the thing of future, mostly for IJ placement. Ultrasound does not help much in subclavian placement and use in femoral placement is limited due to its easy compressibility and less recommended use in ICUs. Are we too negative about femoral vein cannulation? - another debate.

A study just published at ccforum.com where 450 patients who underwent real-time ultrasound-guided cannulation of the internal jugular vein were prospectively compared with 450 patients in whom only the landmarks were used. Have a look at results:

• Cannulation of the internal jugular vein was achieved in all 450 patients by using ultrasound but in 425 of the patients by using the landmark technique.
  
• Average access time - skin to vein - was 17.1 secs (11.5 to 41.4) vs 44 secs (33.2 to 77.5)
  
• Number of attempts were 1.1 vs 2.6.
  
• Puncture of the carotid artery occurred 1.1% vs 10.6% of patients
  
• Haematoma was 0.4% vs 8.4%,
  
• haemothorax was 0% vs 1.7%,
  
• pneumothorax was 0% vs 2.4%
  
• Additional equipment and manipulation associated with the ultrasound method did not increase the rate of catheter-related infection. Actually, central venous catheter-associated blood stream infection was 16% in landmark technique significantly increased compared with the ultrasound group (10.4%).
  
• The number of CVC-BSIs (Blood stream infections) was positively correlated to the number of needle passes in the total study population.
  

You may read the full provisional draft of article (pdf) here 1 - (article also carries ultrasound images).

Note: For those who are interested, The Society of Critical Care Medicine is arranging a pre-congress course to be held in February, 2007 at Orlando, Florida, USA. See here


Related previous pearl: Ultrasound guided insertion of radial artery catheters



Reference: click to get abstract

1. Real-time ultrasound guided catheterization of the internal jugular vein: a prospective comparison to the landmark technique in critical care patients - Critical Care 2006, 10:R162