Vascular access approach for structural heart procedures (original) (raw)
Cureus
Central venous catheterization is a common procedure in the management of critically ill patients, in the context of medical emergencies, and before surgical interventions. Placing a central venous catheter (CVC) in the internal jugular vein (IJV) using anatomical references is associated with a high risk of complications, in particular pneumothorax and arterial puncture. Thus, the placement of CVCs with ultrasound support is recommended by several medical societies and health regulators at the international level. When compared with chest radiography, ultrasound is accessible, safe, cost-effective, and time efficient. This technical report is meant to detail a point-of-care ultrasound protocol designed for the insertion and confirmation of the correct placement of a CVC in the IJV.
Journal of Critical Care, 2016
Objectives: The objective was to survey practicing emergency physicians (EPs) across the United States regarding the frequency of using ultrasound (US) guidance in central venous catheter (CVC) placement and, secondarily, to determine factors associated with the use or barriers to the use of US guidance. Methods: This was a cross-sectional survey mailed to presumed practicing EPs as part of the American Board of Emergency Medicine (ABEM)'s longitudinal study of EPs. The selection process used stratified, random sampling of cohorts thought to represent four different stages within the development of the specialty of emergency medicine (EM). Multivariable logistic regression was used to identify independent factors associated with both high comfort using US guidance and high-percentage usage of US guidance. The survey was mailed to 1,165 subjects, and the response rate was 79%. The median number of years of practice was 20 (interquartile range [IQR] = 7 to 28 years). As their primary practice setting, 64% work in private or community hospitals, 60% received training in US-guided vascular access, and 44% never use US guidance in placing CVCs. Barriers differed in those who never use US and those who sometimes or always used US guidance. In those who never use US, top barriers were insufficient training (67%) and lack of equipment (25%). In those who use US, top barriers were the perceptions that US was too time-consuming (27%) and that the preferred site was not amenable to US (24%). Independent factors associated with high comfort and high-percentage use of US guidance were training in US-guided vascular access (adjusted odds ratio = 5.1 [high comfort]; 95% confidence interval [CI] = 2.6 to 10.1; adjusted odds ratio 11.1 = (high percentage); 95% CI = 5.0 to 24.8) and being a recent residency graduate. Conclusions: Among EPs, the translation of evidence to clinical practice regarding the benefits of US guidance for CVC placement is poor and still faces many barriers. Training and education are potentially the best ways to overcome such barriers.
Ultrasound guidance for placement of central venous catheters
Critical Care Medicine, 1996
Objective: To evaluate the effect of real-time ultrasound guidance using a regular or Doppler ultrasound technique for placement of central venous catheters. Data Sources: We searched for published and unpublished research using MEDLINE, citation review of relevant primary and review articles, conference abstracts, personal files, and contact with expert informants. Study Selection: From a pool of 208 randomized, controlled trials of venous and arterial catheter management, eight published randomized, controlled trials were identified. Data Extraction: In duplicate, independently, we abstracted data on the population, intervention, outcome, and methodologic quality. Data Synthesis: Ultrasound guidance significantly decreases internal jugular and subclavian catheter placement failure (relative risk 0.32; 95% confidence interval 0.18 to 0.55), decreases complications during catheter placement (relative risk 0.22; 95% confidence interval 0.10 to 0.45), and decreases the need for multiple catheter placement attempts (relative risk 0.60; 95% confidence interval 0.45 to 0.79) when compared with the standard landmark placement technique. Conclusions: When used for vessel location and catheter placement real-time, ultrasound guidance or Doppler ultrasound guidance improves success rates and decreases the complications associated with internal jugular and subclavian venous catheter placement. (
International Journal of Medical Research & Health Sciences, 2020
Background: Central Venous Catheter (CVC) is an interventional procedure used during anesthesia and critical care for the administration of drugs, fluids and to measure blood pressure as well as other medical uses. There are two methods for the insertion of a Central Venous Catheter, ultrasound imaging, and anatomical landmarks. The CVC is inserted into a central vein such as the internal jugular, Subclavian, and femoral veins in sterile procedures with as few attempts as possible to reduce complications. Objective: The study aimed to review the incidence of complications during the insertion of central venous catheterization guided by ultrasound versus an anatomical landmark. Methodology: The researchers collected papers that met the criteria and were already published in databases, i.e., the Wiley digital library, Scopus, PubMed, Google Scholar, and Cochrane Databases in the period of (2000-2020). The sample consisted of 25 articles. Mesh headings searched included ultrasound, anatomical landmark, central venous cannulation, and complications. Result: Findings of 24 (96%) Randomized Controlled Trials (RCT) in different parts of the world revealed that the ultrasound imaging method has fewer complications than anatomical landmark during central venous cannulation, A p-value<0.05, and only 1(4%) study showed the insignificance with the p-value is >0.05. Conclusion: According to all previous studies, the review concluded that ultrasound imaging is more effective in reducing complications compared to the anatomical landmark technique in patients requiring central venous catheter insertion. And this review is recommending further studies to discover other factors that can reduce the complications.
Journal of Society of Anesthesiologists of Nepal, 2016
Background: Catheterization of internal jugular vein can be achieved by either anatomical landmark technique or the ultrasound guided technique. The objective of our study is to find out if ultrasound guided technique could be beneficial in placing central venous catheters by improving the success rate by reducing the number of attempts, decreasing the access time and decreasing the complications rate in comparison to the landmark technique. Methods: Fifty patients scheduled for cardiac surgery requiring central venous cannulation of the right internal jugular vein were divided into two groups: ultrasound guided group 'U' and the landmark group 'L', each consisting of 25 patients with age more than 15 years. The outcomes were compared in terms of success rate, time taken for successful cannulation and rate of complications. Results: The two groups were comparable in terms of age, weight, heart rate and blood pressure. The mean number of attempts for successful cannulation was 1.08±0.277 and 1.40±0.764 (p=0.055), the time taken in seconds for successful cannulation was 108.56±27.822 and 132.08±72.529 (p=0.137) and the overall complication rate was 0% (0 out of 25) and 32% (8 out of 25) (p=0.02) in the ultrasound guided and the landmark technique group respectively. Conclusion: Ultrasound guided central venous catheterization of internal jugular vein is comparable to the landmark technique in terms of number of attempts and the time required for successful cannulation. Ultrasound guided technique is much safer than the landmark technique to reduce the overall complications rate during central venous cannulation.
Ultrasound-guided central venous catheter insertion: teaching and learning
Intensive Care Medicine, 2014
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Objective: To determine the advantages of ultrasound guided central venous catheter insertion over anatomical land mark technique regarding ease of insertion and safety. Methodology: Sixty elective patients requiring central venous catheter were selected and randomly divided into two groups, e.g. ultrasound and anatomical landmark groups. Central catheter was inserted under aseptic measures by the same operator. Variables including ease of access, number of attempts, arterial punctures and other complications in both groups were recorded. Results: Ultrasound guidance in central catheter insertion resulted in a statistically significant ease of insertion (P = 0.024). while decreasing number of attempts to gain venous access as compared to the anatomical landmark group (p = 0.0453). Two cases of arterial puncture were recorded in the anatomical landmark group while no arterial puncture occurred in the ultrasound group. P <0.05 was considered significant. Conclusion: Ultrasonographic guidance for central catheter insertion makes it easy and safe as it allows better identification of vascular structures. It also reduces the rate of complications associated with central catheter insertion and improves the success rate thereby justifies its cost. Citation: Rehman A, Zeb H, Niazi AUK. Ultrasound guidance increases the safety and ease of insertion of central venous catheters in patients undergoing elective procedures. Anaesth Pain& Intensive Care 2015;19(4):474-477