A comparison between ultrasound-guided central venous line placement and an anatomical landmark technique

Introduction

Ultrasound has been introduced in the insertion of central venous lines to reduce the complications associated with the conventional landmark technique [1]. We compared both techniques; we noted the number of attempts, the duration of insertion and complications.

Methods

Thirty patients were randomly selected, from the operating theatre and ICU, who required placement of a central venous catheter. The central venous catheter placement was performed by two experienced anaesthetists with more than 6 years experience in anaesthesia and intensive care. In 15 patients the internal jugular venous catheter placement was performed using the external anatomical landmark technique, and in the other 15 patients the placement was under ultrasound guidance. The duration of insertion was recorded from the moment the needle touched the skin until insertion of the catheter and removal of the guide wire. The numbers of attempts as well as immediate or delayed complications were recorded.

Results

The central venous catheter placement was successfully performed from the first attempt in both groups. There were no immediate or delayed complications noted; however, the mean time of insertion was longer in the ultrasound-guided group (4.55 min) compared with the external anatomical landmark group (2 min) (Figure 1).

Figure 1

(abstract P160)

Discussion

Some studies have been designed to evaluate ultrasound-guided central venous catheter placement compared with the conventional method based on external anatomical landmarks. These studies demonstrated the superiority of ultrasound-guided central venous line placement over the external anatomical landmark technique. However, there was no time gain demonstrated in ultrasound-guided placement [2]. On the other hand, a number of studies have expressed several reservations concerning the systematic use of ultrasound guidance for central line placement [3]. In our patients we found that the use of ultrasound neither altered the rate of complication nor the number of attempts in central venous catheter placement. Also the duration of placement of the central line catheter using the external anatomical landmark technique was shorter than in the ultrasound-guided method.

Conclusion

The external anatomical landmark technique in central line placement is considered a safe method with experienced hands. The time of insertion of a central line using the external anatomical landmark technique was shorter than the ultrasound-guided placement method. It is essential for all trainees to be taught both methods for central line placement to be able to place a central line catheter quickly and safely in emergency situations and when an ultrasound machine is not available.