Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit*

Froehlich, Curt D.; Rigby, Mark R.; Rosenberg, Eli S.; Li, Ruosha; Roerig, Pei Ling J; Easley, Kirk A.; Stockwell, Jana A.

doi:10.1097/ccm.0b013e31819b570e

Cited by 226 publications

(160 citation statements)

References 22 publications

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“…Although it is known that thrombosis is not usually associated with needle insertion but occur after catheter placement, we think that the reduced number of attemps reduces the vein trauma and the thrombosis as well. 3,16,17 Similar with our results Alten et al showed that there were fewer complications of venous thrombosis in patients where ultrasound was used compared with the standard landmark technique, but the results were not statistically significant. 18 No potential mechanical complications (arterial puncture, malposition, arrhythmia and pneumothorax) associated with catheter insertion occurred in our study.…”

Section: Resultssupporting

confidence: 82%

See 1 more Smart Citation

Use of ultrasound for central venous catheterization in pediatric intensive care unit; a single center experience

Tolunay¹,

Okuyan²,

Çelik³

et al. 2015

Turk J Ped Em Int Care Med

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Methodsby an interventional radiology expert. Subclavian vein was not preferred since it complicated the insertion of the catheter into the clavicle under ultrasound guidance. Adequate anesthesia was achieved prior to the procedure (1 μgr/kg fentanyl); sedation was ensured using midazolam (0,1 mg/kg) or ketamine (1-2 mg/kg). During the procedure, the patients were followed under continuous monitoring of the cardiac rate and rhythm, the respiratory rate and oxygen saturation. Except emergency situations, patients with pre-existing thrombocytopenia and abnormal coagulation test results were given supportive treatment and the catheter was inserted in these patients after the test results returned to normal. Central venous catheters were inserted by the pediatricians employed at the intensive care unit or interventional radiology expert at the pediatric intensive care unit. Double-lumen 4-Fr, triple-lumen 5-Fr, triple-lumen 7-Fr polyurethane transient catheters were used for patients with a body weight below 5 kg, between 5 and 20 kg and above 20 kg, respectively (Guangdong Baihe Medical Technology, China).For the purpose to recognize artery and vein; 1-the anatomic positions of internal jugular and femoral veins relative to arteries (internal jugular vein lies on the lateral side of the common carotid artery, femoral vein lies on the medial side of the femoral artery) (figure 1,2), 2-the compressibility of the internal jugular and femoral veins relative to arteries (figure 1,2), 3-in case of difficulty of discriminating the veins and arteries, the shape of the flow was investigated using Doppler mode of ultrasound (Figure 3). While transverse access was mostly used due to the size of the ultrasound probe, CVC was conducted using longitudinal access with real-time images in older patients (figure 4).Hand hygiene and aseptic conditions were ensured to manage infections. The site of administration was sterilized using 10% povidone iodine. A sterile ultrasound gel (Aquatouch Jelly, Turkey) and sterile transducer cover (Medbar Cardboard Camera Cover, Turkey) was used. While inserting the catheter, a "laptop style" ultrasound device and a straight linear probe (7.5 MHz) was used (Mindray-M5 Ultrasound System, China). The catheters were inserted using the Seldinger technique. The location of the catheter was assessed by posterior-anterior chest radiograph for the internal jugular catheters and the localization was deemed appropriate if the tip of the catheter was in the space between the distal part of vena cava superior and the entrance of the right atrium. Dressings were applied once every two days. Patients exhibiting the same microorganism growth in the catheter culture and the peripheral blood culture with accompanying the sepsis clinical findings and signs were diagnosed as central line-associated bloodstream infection while those with erythema, indurations and tenderness within 2 cm distance around the catheter exit were diagnosed with catheter exit-site infection 9 .

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Section: Resultssupporting

confidence: 82%

“…In similarity to our results, Froeclich et al reported that the use of ultrasonography reduced complications and particularly the arterial puncture. 17 One patient in our study developed central line-associated bloodstream infection following insertion. The rate of infection was 1.22 per 1000 catheter days.…”

Section: Resultsmentioning

confidence: 99%

Use of ultrasound for central venous catheterization in pediatric intensive care unit; a single center experience

Tolunay¹,

Okuyan²,

Çelik³

et al. 2015

Turk J Ped Em Int Care Med

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“…Published data support the use of ultrasound by acute care professionals not traditionally trained in the ultrasound technique in the emergency medicine, anesthesia and adult and pediatric critical care literature. [23][24][25][26][27][28] Most labor and delivery, as well as emergency departments routinely use portable ultrasound devices. Small portable devices are being used clinically in other areas of critical care.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided umbilical catheter insertion in neonates

Fleming

Kim

2011

J Perinatol

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Objective: Umbilical catheter placement is a routine neonatal emergency procedure that has large variability in technical methods. Commonly used methods are unable to accurately estimate insertion lengths, and X-rays cannot always identify malpositioned catheters. In clinical practice, the placement of umbilical lines takes time away from nursing during a critical transition period. Ultrasound is a safe and commonly used tool in the nursery for clinical management of sick neonates and has been shown to readily identify central catheter tip position. In this study, we sought to determine a more time-efficient and accurate means of umbilical catheter placement using bedside ultrasound.Study Design: This is a prospective, randomized, pilot trial of infants of any age or weight admitted to the neonatal intensive care unit who required umbilical catheter placement. Infants were excluded if they had congenital heart disease, abdominal wall defects or had a single umbilical artery. Catheters were placed using either the conventional method, with blinded evaluation of the catheters using ultrasound, or with ultrasound guidance, with input pertaining to catheter tip location. The number of X-rays required to confirm proper positioning, completion time points throughout the procedure and manipulations of the lines were recorded for both groups.Result: Ultrasound use decreased the time of line placement with an average saving of 64 min, as well as decreased the number of manipulations required and X-rays taken to place the catheters. The average X-ray time from request to viewing per X-ray was 40 min for all subjects.Conclusion: Ultrasound-guided umbilical catheter placement is a faster method to place catheters requiring fewer manipulations and X-rays when compared with conventional catheter placement.

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“…As to the number of attempts, Verghese et al (2000) found no difference in the number of arterial punctures when comparing both techniques [23]; nevertheless, the same authors reported, in 1999, a smaller number of attempts when CVC was guided by USG [24], which was to be later confirmed by Froelich et al (2009) [25]. Jijeh et al (2014) were successful at the first attempt in 75% of USG-guided punctures (mean time 3.9 minutes), 23% at the second one, and 2%…”

Section: Introductionmentioning

confidence: 59%

Ultrasound-Guided Central Venous Catheterization: A Protocol to Be Followed in Pediatrics?

Marques¹,

Cesar²

2017

OJPed

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Objective: To investigate the effectiveness of ultrasound-guided central venous catheterization when compared to the conventional procedure. Method: A prospective cohort study was carried out over a 9-month period from February to October 2016 involving 144 inpatients at PICU of Irmandade da Santa Casa de São Paulo Hospital, undergoing central venous catheterization. The patients were matched in pairs of identical patients according to the levels of potentially intervening variables (age, nutritional status, puncture site, professional experience), differing only as to the CVC technique: ultrasound-guided (USG-CVC) or conventional (C-CVC). Discarding data from non-paired patients, the remaining did forming 47 pairs, matched as two related samples: USG-CVC and C-CVC groups. Success parameters: number of puncture attempts; time spent at CVC; success rate and complications. Results: In the USG-CVC group, the number of attempts (mean = 2.04) and the time spent at catheterization (mean = 11.89 minutes) were lower (t = 2.34, df = 46, t 0.95 = 2.02, p < 0.05) and (t = 3.07, df = 46, t 0.95 = 2.02, p < 0.05), respectively, when compared to the results obtained for the control group (C-GVC), (mean = 3.21) and (mean = 28.26 minutes), respectively. As to success, there was observed a significant difference (F (1, 46) = 16.6; Q (1) = 12.5, p < 005) when considering only one trial (USG -CVC = 27/47; C-CVC = 9/47), but no significant difference (F (1, 46) = 3.76; Q (1) = 3.56, p > 0.05) when considering several attempts. Complications were found less frequently in the USG-CVC group (3/47) than in the CVC-C (13/47), (F (1, 46) = 8.24; Q (1) = 7.14, p < 0.05). Conclusion: USG-CVC was found to be more effective than the conventional technique, especially regarding success at the first puncture attempt.

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Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit*

Cited by 226 publications

References 22 publications

Use of ultrasound for central venous catheterization in pediatric intensive care unit; a single center experience

Use of ultrasound for central venous catheterization in pediatric intensive care unit; a single center experience

Ultrasound-guided umbilical catheter insertion in neonates

Ultrasound-Guided Central Venous Catheterization: A Protocol to Be Followed in Pediatrics?

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