Uncomplicated Central Vein Catheterization of High Risk Patients with Real Time Ultrasound Guidance

Abstract

Internal jugular vein cannulation has become a routine and clinically important aspect of medical care of critically ill patients. The landmark guided technique usually affords rapid and easy vascular access, but is not always successful and may be complicated by arterial puncture, hematoma, or pneumothorax. Some categories of patients, in particular patients with no external landmarks and patients with coagulopathies, appear to be at an increased risk of complications. We report the experience of internal jugular vein cannulation by a single operator with the external landmark technique in 10 patients and with ultrasound guidance in 31 patients, including 12 high risk patients. These patients had severe coagulopathies due to hepatic failure, HELLP syndrome, excess of anticoagulation treatment, or they had no external anatomic landmarks because of anasarca or obesity, were unable to maintain the horizontal position, or were external landmark catheterization failures. With the availability of the ultrasound device, success and complication rates improved markedly, suggesting that the ultrasound technique is easy to learn and rapidly produces an improvement over the external landmark method. In particular the 13 cannulations performed in 12 high risk patients were all successful at the first attempt, with no complications. In the overall population successful cannulations improved from 80% to 100%, first attempt success from 20% to 87% and carotid punctures decreased from 33% to 3.2%. Our results confirm that ultrasound guided cannulation of the internal jugular vein allows safer operation in high risk patients or when access problems are anticipated.

Venous pseudo-aneurysm as a late complication of short-term central venous catheterisation

“…Patients who are either obese or who have short neck represent an additional challenge to such an extent that cannulation, then, becomes safer by using ultrasound guidance [8]. …”

“…It seems fair to conclude that in high-risk patients (as in this case with planned post-operative anticoagulation), multiple attempts at puncturing the same central vein should be avoided and alternative routes should be used if one attempt fails. Moreover, the use of ultrasound to locate the vein prior to catheterization will reduce the need for multiple blind attempts [8,10]. …”

Evaluation of an ultrasound-guided technique for central venous access via the internal jugular vein in 493 patients

“…The advantages of sonographically guided catheter placement over the classic technique based on the use of anatomical landmarks have been confirmed in nonrandomized and randomized comparisons in a large number of investigations [1,2,5,8,9,10,13,15,16,20,23,24]. A meta-analysis published by Randolph [21] describes a lower failure rate in the sonographically guided puncture group in six out of seven randomized studies of placement of central venous catheters in the jugular vein (relative risk (RR) 0.38; confidence interval (KI) 0.21-0.71).…”

A Randomized Controlled Trial Comparing One-Operator Versus Two-Operator Technique in Ultrasound-Guided Basilic Vein Cannulation

“…The use of bedside ultrasound to facilitate venous access has been described in numerous specialties, including emergency medicine (1)(2)(3)(4)(5). Ultrasound-guided central venous access has been found to reduce complications and reduce time-to-cannulation (6,7). However, the role of ultrasound in facilitating peripheral intravenous access in the ED is unclear.…”