Safety of a training program for ultrasound-guided internal jugular vein catheterization in critically ill patients

Purpose: Central venous catheter insertion is a common procedure in the intensive care setting. However, complications persist despite real-time ultrasound guidance. Recent innovation in needle navigation technology using guided positioning system enables the clinician to visualize the needle’s real-time position and trajectory as it approaches the target. We hypothesized that the guided positioning system would improve performance time in central venous catheter insertion. Methods: A prospective randomized study was conducted in a single-center adult intensive care unit. In total, 100 patients were randomized into two groups. These patients underwent internal jugular vein central venous catheter cannulation with ultrasound guidance (short-axis scan, out-of-plane needling approach) in which one group adopted conventional method, while the other group was aided with the guided positioning system. Outcomes were measured by procedural efficacy (success rate, number of attempts, time to successful cannulation), complications, level of operators’ experience, and their satisfaction. Results: All patients had successful cannulation on the first attempt except for one case in the conventional group. The median performance time for the guided positioning system method was longer (25.5 vs 15.5 s; p = 0.01). And 86% of the operators had more than 3-year experience in anesthesia. One post-insertion hematoma occurred in the conventional group. Only 88% of the operators using the guided positioning system method were satisfied compared to 100% in the conventional group. Conclusion: Ultrasound-guided central venous catheter insertion via internal jugular vein was a safe procedure in both conventional and guided positioning system methods. The guided positioning system did not confer additional benefit but was associated with slower performance time and lower satisfaction level among the experienced operators.

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Comparative analysis of mechanical complications of emergency versus planned ultrasound-guided internal jugular venous (IJV) cannulation: data from the emergency room of a third-level hospital in Quito, Ecuador

Maldonado

Vidal

Porter

et al. 2020

F1000Res

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Background: Central venous catheters (CVC’s) are useful tools for the treatment of critically ill patients, especially in the emergency room, and are recognized for decreasing rates of failure and mechanical complications. Certain parameters can act as predictors to determine the likelihood of this type of complication. The aim of this study is to determine the incidence and predictors of mechanical complications using internal jugular venous (IJV) cannulation, especially when considering planned versus emergency cannulation. Methods: A prospective, observational study was performed at Hospital de los Valles, Quito, Ecuador, during a three-year period. All patients who presented to the emergency room with an indication for IJV cannulation and with no potential contraindications were included. Demographic, safety and procedure related data were collected. Variables were analyzed using STATA, and p-values <0.05 were considered significant. Results: A total of 142 patients were included. The majority of procedures (64%) were planned. The main indication for CVC placement via IJV cannulation was chronic renal failure (54%), all of which were planned procedures, followed by sepsis (15%), where most procedures (91%) were emergencies. The IJV was anatomically located lateral to the carotid artery in 38.73% of cases. Mechanical/technical complications were reported in 13 patients. Cannulation time greater than two minutes was found to be the only factor independently associated with a higher probability (12.4 times) of developing mechanical/technical complications. The vessel location did not affect the incidence of complications either in emergency or planned procedures when using ultrasound. Conclusions: Ultrasound-guided IJV cannulation is a safe technique that can be performed as an emergency or planned procedure without increased complication rates in the emergency room. Additionally, a puncture time of less than two minutes is associated with the safest profile in this patient population.

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Safety of a training program for ultrasound-guided internal jugular vein catheterization in critically ill patients

Abstract: Learning ultrasound guidance for IJV vein cannulation was safe and feasible in ICU patients. This process was not associated to complications and better results were achieved across the spectrum of operator experience.

Cited by 5 publications

References 16 publications

Analysis of the Outcomes in Central Venous Access Port Implantation Performed by Residents via the Internal Jugular Vein and Subclavian Vein

Analysis of the Outcomes in Central Venous Access Port Implantation Performed by Residents via the Internal Jugular Vein and Subclavian Vein

Ultrasound-guided central venous vascular access—novel needle navigation technology compared with conventional method: A randomized study

Comparative analysis of mechanical complications of emergency versus planned ultrasound-guided internal jugular venous (IJV) cannulation: data from the emergency room of a third-level hospital in Quito, Ecuador

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