Thursday October 16, 2008
Why ultrasound guided central line placement


Study: Real-time ultrasonographic guidance is compared to the traditional landmark technique for the insertion of internal jugular vein catheters in an emergency department (ED) setting. This was a prospective, randomized, clinical study. 130 patients were enrolled.

Outcome measures: Successful insertion of an internal jugular vein catheter, number of attempts, access times, and complications.


Results

• Cannulation of the internal jugular vein was successful in 61 of 65 patients (93.9%) using ultrasonography and in 51 of 65 patients (78.5%) using the landmark technique, a significant difference of 15.4%
• Fifty of 61 (82.0%) of the successful ultrasonographically guided catheters were inserted on the first attempt compared with 36 of 51 (70.6%) of the successful landmark catheters.
• Mean access times to venipuncture and successful insertion were 138 and 281 seconds by ultrasonographic guidance and 132 and 271 seconds by the landmark technique.
• There was a 10.8% complication rate, with 11 complications (16.9%) in the landmark group and 3 (4.6%) in the ultrasonographic group, a difference of 12.3%

Conclusion: Ultrasonographically guided internal jugular vein catheterization in the ED setting was associated with a higher successful insertion rate and a lower complications rate.




Reference: click to get article

Ultrasonographic Guidance for Internal Jugular Vein Cannulation: An Educational Imperative, A Desirable Practice Alternative , Alfredo Sabbaj, Jerris R. Hedges, Annals of Emergency Medicine, November 2006 (Vol. 48, Issue 5, Pages 548-550)