Ultrasonography: A novel approach to central venous cannulation

Abstract

Background:Portable ultrasound machines are highly valuable in ICUs, where a patient's condition might not permit shifting the patient to the USG department for imaging. Traditionally central lines are put blindly using anatomical landmarks, which often result in complications such as difficulty in access, misplaced lines, pneumothorax, bleeding from inadvertent arterial punctures, etc. Ultrasonography provides “real time” imaging, i.e., the needle can be visualized entering the vein.Aims:We performed a study to compare USG guided central venous cannulation (CVC) and conventional anatomical landmark approach to CVC, in terms of ease of cannulation, time consumed, and associated complications.Settings and Design:The study was performed in a 16-bed open ICU. Eighty patients were randomly divided in two groups.Materials and Methods:The right internal jugular vein (IJV) was cannulated in all. In Group I, a portable ultrasound machine was used during cannulation. The vessels were visualized in the transverse section with the internal carotid artery (ICA) identified as a circular pulsatile structure, while the IJV as a lateral, oval nonpulsatile structure). The needle was inserted perpendicular to the skin under visualization on the US screen. Central venous line was then inserted by the Seldinger technique. In Group II, CVC was performed by the conventional landmark approach. The parameters studied included time for insertion, attempts required, and complications encountered.Statistical Analysis:The database of all parameters was analyzed using SPSS software version 10.5.Results:The mean time to successful insertion was 145 and 176.4 sec in groups I and II, respectively (p = 0.00). An average of 1.2 attempts per cannulation was required for group I, while 1.53 for group II (p = 0.03): 10% witnessed arterial puncture and 2.5% pneumothorax in group I and none in group II.Conclusion:USG-guided CVC is thus easier, quicker, and safer than landmark approach.

Comparison of US-Guided Catheterization of the Right Internal Jugular Vein Using Medial-Oblique and Short Axis Techniques

“…The average number of attempts was 1.25 in Group 1 (SAG) and 1 -1.5 in other investigations (8,11,12,16,17,19,21). The results also demonstrated no statistically significant difference between the two study groups concerning the mean number of attempts.…”

“…The findings of the current study showed no clinical complications of catheterization in Group 1 (SAG), while this measure was 0 -3% in other studies (1, 7-9, 11-17, 19, 21). The incidence rate of hematoma was also 0% in this study and 0 -4.3% in other investigations (1,7,8,11,13,(15)(16)(17). Moreover, there was no statistically significant difference between the two groups with respect to primary mechanical complications.…”

“…Successful catheterization rate in the first attempt was 85% in Group 1 (SAG) compared to 63 -100% in other investigations (8,9,13,(15)(16)(17)(18)(19)(20). In addition, successful catheterization rate in the second attempt was 5% in Group 1 (SAG) and 2 -10% in other studies (14,16).…”

An Entirely Echo-Guided Technique for Totally Implantable Access Port Positioning

“…There is compelling evidence that US-guided venipuncture by real-time US is associated with a lower incidence of complications and a higher rate of success than blind venipuncture. It has also been shown as quicker and safer than the landmark method in both adults and children [4,[7][8][9][10]. However, the blind cannulation of a central vein method is still used in many centers.…”

Ultrasound guided emergency cannulation of internal jugular vein in coagulopathic adult patients – a prospective observational pilot study.

“…Another advantage that USG cannulation offers is the visualization of vessels in hypotensive patients in whom carotid artery is difficult to palpate for landmark identification. 3 With the advent of portable and affordable ultrasound…”