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VOLUME 13 , ISSUE 4 ( December, 2009 ) > List of Articles

RESEARCH ARTICLE

Ultrasonography: A novel approach to central venous cannulation

Anil P. Singh, Dinesh K. Singh

Keywords : central venous cannulation, intensive care unit, ultrasound

Citation Information : Singh AP, Singh DK. Ultrasonography: A novel approach to central venous cannulation. Indian J Crit Care Med 2009; 13 (4):213-216.

DOI: 10.4103/0972-5229.60174

License: CC BY-ND 3.0

Published Online: 01-10-2012

Copyright Statement:  Copyright © 2009; The Author(s).


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.


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  1. Randomized, controlled clinical trial of point-of-care limited ultrasonography assistance of central venous cannulation: The third sonography outcomes assessment program (SOAP-3) trial. Crit Care Med 2005;33:1764-9.
  2. Real time ultrasonographically guided internal jugular vein catheterization in the emergency department increases success rates and reduces complications: A randomized, prospective study. Ann Emerg Med 2006;48:540-7.
  3. Facilitation of internal jugular venous cannulation using an audio-guided doppler ultrasound vascular access device: Results from a prospective, dual-center, randomized, crossover clinical study. Crit Care Med 1995;23:60-5.
  4. Making health care safer: A critical analysis of patient safety practices. Evid Rep Technol Assess (Summ) 2001;43:1-668.
  5. A survey of the use of portable ultrasound for central vein cannulation on critical care units in the UK. Anaesthesia 2002;57:365-8.
  6. A survey of the use of ultrasound during central venous catheterization. Anesth Analg 2007;104:491-7.
  7. Where is the harm in using ultrasound guidance? bmj.com, 2002; Available from: http://bmj.com/cgi/eletters/325/7377/1373. [cited in 2002].
  8. Effectiveness of a novel training program for emergency medicine residents in ultrasound guided insertion of central venous catheters. CJEM 2009;11:343-48.
  9. Asepsis in ultrasound guided central venous access: A new technique. Ann Emerg Med 2009;54:S100.
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