Use of ultrasound for central venous catheter placement

Introduction

The placement of a central venous catheter is a common practice in the ICU and the incidence of mechanical complications occurs is 5–19% of patients. In this study we compare the ultrasound approach with classic landmark technique in terms of reduction of mechanical complications and the number of attempts needed for the cannulation of the internal jugular vein.

Methods

We examined 31 patients admitted to the ICU: in 20 of them the cannulation of the internal jugular vein was obtained using real-time ultrasound guidance, while in 11 patients we employed the landmark technique (axial approach). We recorded the number of complications and the number of attempts, correlating with the experience of the operator. All data were statistically examined with Student's t test (number of attempts) and Fisher's test for count of odds ratio (incidence of complications).

Results

We reported 9% of complications in the landmark group (one accidental arterial puncture) and 6% in the ultrasound group (one pneumothorax). The odds ratio for these data is 0.5 (95% CI = 0.006–45.4). We found a statistically significant difference in the number of attempts performed, with a lower value in the ultrasound group (mean ± SD, ultrasound 1.1 ± 0.30 vs landmark technique 1.7 ± 0.78; P = 0.034). No difference in the number of attempts was evidenced by the experience of the operator using the ultrasound approach. See Figure 1.

Figure 1

Conclusion

Our data confirm that use of ultrasound for central venous catheter placement is safer and is associated with a lower risk of complications than the classical approach, especially for low-experience operators.