Optimization of Cannula Visibility during Ultrasound-Guided Subclavian Vein Catheterization, via a Longitudinal Approach, by Implementing Echogenic Technology

Objective. One limitation of ultrasound-guided vascular access is the technical challenge of visualizing the cannula during insertion into the vessel. We hypothesized that the use of an echogenic vascular cannula (EC) would improve visualization when compared with a nonechogenic vascular cannula (NEC) during real-time ultrasound-guided subclavian vein (SCV) cannulation in the ICU.Material and Methods. Eighty mechanically ventilated patients were prospectively enrolled in a randomized study that was conducted in a medical-surgical ICU. Forty patients underwent EC and 40 patients were randomized to NEC. The procedure was ultrasound-guided SCV cannulation via the infraclavicular approach on the longitudinal axis.Results. The EC group exhibited increased cannula visibility as compared to the NEC group (92%±3%versus85±7%, resp.,P<0.01). There was strong agreement between the procedure operators and independent observers (k=0.9, 95% confidence intervals assessed by bootstrap analysis = 0.87 to 0.93;P<0.01). Access time (12.1 s±6.5versus18.9 s±10.9) and the perceived technical difficulty of the ultrasound method (4.5±1.5versus7.5±1.5) were both decreased in the EC group compared to the NEC group (P<0.05).Conclusions. Echogenic technology significantly improved cannula visibility and decreased access time and technical complexity optimizing thus real-time ultrasound-guided SCV cannulation via a longitudinal approach.

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Echogenic Technology Improves Cannula Visibility during Ultrasound-Guided Internal Jugular Vein Catheterization via a Transverse Approach

Critical Care Research and Practice ◽

10.1155/2012/306182 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5

Author(s):

Konstantinos Stefanidis ◽

Nicos Pentilas ◽

Stavros Dimopoulos ◽

Serafim Nanas ◽

Richard H. Savel ◽

...

Keyword(s):

Real Time ◽

Internal Jugular Vein ◽

Jugular Vein ◽

Central Venous Access ◽

Randomized Study ◽

Venous Access ◽

Access Time ◽

Ultrasound Guided ◽

Bootstrap Analysis ◽

Mechanical Complications

Objective.Echogenic technology has recently enhanced the ability of cannulas to be visualized during ultrasound-guided vascular access. We studied whether the use of an EC could improve visualization if compared with a nonechogenic vascular cannula (NEC) during real-time ultrasound-guided internal jugular vein (IJV) cannulation in the intensive care unit (ICU).Material and Methods.We prospectively enrolled 80 mechanically ventilated patients who required central venous access in a randomized study that was conducted in two medical-surgical ICUs. Forty patients underwent EC and 40 patients were randomized to NEC. The procedure was ultrasound-guided IJV cannulation via a transverse approach.Results.The EC group exhibited increased visibility as compared to the NEC group (88% ± 8% versus 20% ± 15%, resp.P<0.01). There was strong agreement between the procedure operators and independent observers (k=0.9; 95% confidence intervals assessed by bootstrap analysis = 0.87–0.95;P<0.01). Access time (5.2 s ± 2.5 versus 10.6 s ± 5.7) and mechanical complications were both decreased in the EC group compared to the NEC group (P<0.05).Conclusion.Echogenic technology significantly improved cannula visibility and decreased access time and mechanical complications during real-time ultrasound-guided IJV cannulation via a transverse approach.

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Faculty Opinions recommendation of Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: a prospective randomized study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13183957.14522059 ◽

2011 ◽

Author(s):

Alain Vuylsteke ◽

Julia Neely

Keyword(s):

Critical Care ◽

Real Time ◽

Subclavian Vein ◽

Randomized Study ◽

Prospective Randomized Study ◽

Ultrasound Guided ◽

Vein Cannulation ◽

Critical Care Patients

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Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: A prospective randomized study*

Critical Care Medicine ◽

10.1097/ccm.0b013e318218a1ae ◽

2011 ◽

Vol 39 (7) ◽

pp. 1607-1612 ◽

Cited By ~ 205

Author(s):

Mariantina Fragou ◽

Andreas Gravvanis ◽

Vasilios Dimitriou ◽

Apostolos Papalois ◽

Gregorios Kouraklis ◽

...

Keyword(s):

Critical Care ◽

Real Time ◽

Subclavian Vein ◽

Randomized Study ◽

Prospective Randomized Study ◽

Ultrasound Guided ◽

Vein Cannulation ◽

Critical Care Patients

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A Study of Malposition of Central Venous Catheter – A Comparative Study between Ultrasound Guided and Anatomical Landmark Technique

Birat Journal of Health Sciences ◽

10.3126/bjhs.v2i3.18943 ◽

2018 ◽

Vol 2 (3) ◽

pp. 277-281

Author(s):

Lalit Kumar Rajbanshi ◽

Sambhu Bahadur Karki ◽

Batsalya Arjyal

Keyword(s):

Real Time ◽

Internal Jugular Vein ◽

Subclavian Vein ◽

Jugular Vein ◽

Venous Catheter ◽

Anatomical Landmark ◽

Ultrasound Guided ◽

Central Venous ◽

Catheter Tip ◽

Landmark Technique

Introduction: Central venous catheterization is a routine procedure for long-term infusion therapy and central venous pressure measurement. Sometimes, the catheter tip may be unintentionally placed at the position other than the junction of superior vena cava and right atrium. This is called malposition and can lead to erroneous pressure measurement, increase risk of thrombosis, venous obstruction or other life threatening complications like pneumothorax, cardiac temponade.Objectives: This study aimed to observe the incidence of the malposition and compare the same between ultrasound guided catheterization and blind anatomical landmark technique.Methodology: This study was a prospective comparative study conducted at the intensive care unit of Birat Medical College and Teaching Hospital for two-year duration. All the catheterizations were done either with the use of real time ultrasound or blind anatomical landmark technique. The total numbers of central venous catheterization, the total incidences of malposition were observed. Finally the incidences were compared between real time ultrasound guided technique and blind anatomical landmark technique.Results: In two-year duration of the study, a total of 422 central venous cannulations were successfully done. The real time ultrasound was used for 280 cannulations while blind anatomical landmark technique was used for 162 patients. The study observed various malposition in 36 cases (8.5%). The most common malposition was observed for subclavian vein to ipsilateral internal jugular vein (33.3%) followed by subclavian to subclavian vein (27.8%) and internal jugular to ipsilateral subclavian vein (16.7%). In four patients the catheter had a reverse course in the internal jugular vein while the tip was placed in pleural cavity in three cannulations. There was coiling of the catheter inside left subclavian vein in one patient. The malposition was significantly reduced with the use of the real time ultrasound (P< 0.001). However there is no significant difference in the incidence of the various malposition between ultrasound guidance technique and blind anatomical landmark technique when compared individually.Conclusion: The malposition of the central venous catheter tip was common complication with the overall incidence of 8.5%. The most common malposition was subclavian vein to internal jugular vein. The use of real time ultrasound during the catheterization procedure can significantly reduced the risk of malposition.Birat Journal of Health SciencesVol.2/No.3/Issue 4/Sep- Dec 2017, Page: 277-281

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Percutaneous Renal Biopsy: Comparison of Blind and Real-time Ultrasound Guided Technique

Journal of Nepal Health Research Council ◽

10.3126/jnhrc.v16i1.19369 ◽

2018 ◽

Vol 16 (1) ◽

pp. 66-72 ◽

Cited By ~ 2

Author(s):

Anil Pokhrel ◽

Rajendra Kumar Agrawal ◽

Anil Baral ◽

Ajaya Rajbhandari ◽

Rajani Hada

Keyword(s):

Renal Biopsy ◽

Real Time ◽

Randomized Study ◽

Bleeding Complications ◽

Renal Diseases ◽

Ultrasound Guided ◽

Macroscopic Hematuria ◽

Percutaneous Renal Biopsy ◽

Significant Difference ◽

Perinephric Hematoma

Background: Percutaneous renal biopsy is performed for diagnosis and prediction of prognosis of renal diseases. Adequacy of tissue and clinically significant bleeding are the main issues of the procedure. We aimed to compare these issues in renal biopsy by blind and real time ultrasound guided technique.Methods: It was a cross sectional, randomized study conducted between June 2016 to December 2016. In blind technique, marking for biopsy was done by ultrasound. Two attempts were performed for all and more if tissue was inadequate. Patients kept in bed rest for 24 hours, observed for post procedure hematuria and ultrasound done at 6 hours and 24 hours to diagnose perinephric hematoma.Results: Total 75 biopsies (blind = 37 and Ultrasound -guided = 38) were evaluated. Blind and Ultrasound-guided technique had significant difference of number of attempt (mean±SD) 2.4±0.6 and 2.1±0.3 (p<0.01) respectively with no difference of number of glomeruli in light microscopy. Bleeding complications were macroscopic hematuria (11(30%)vs15(40%)) and perinephric hematoma ( 5(13.5%)vs3(7.9%)) in blind and Ultrasound-guided technique respectively with no significant difference. Those patients who developed perinephric hematoma was observed in all at 6 hours.Conclusions: Ultrasound-guided technique of percutaneous renal biopsy is superior with fewer attempts and equivalent in adequacy of tissue and bleeding complication than blind technique.

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A comparison of real-time ultrasound-guided method and anatomical landmark technique for subclavian vein catheterization

10.26226/morressier.57108e32d462b80290b4abfc ◽

2016 ◽

Author(s):

Hedi Charrada

Keyword(s):

Real Time ◽

Subclavian Vein ◽

Anatomical Landmark ◽

Ultrasound Guided ◽

Landmark Technique ◽

Vein Catheterization

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Real-time ultrasound-guided subclavian vein cannulation in cardiac surgery: comparison between short-axis and long-axis techniques

Critical Care ◽

10.1186/cc13322 ◽

2014 ◽

Vol 18 (Suppl 1) ◽

pp. P132

Author(s):

F Corradi ◽

T Manca ◽

C Brusasco ◽

F Cocconcelli ◽

A Agostinelli ◽

...

Keyword(s):

Cardiac Surgery ◽

Real Time ◽

Subclavian Vein ◽

Short Axis ◽

Ultrasound Guided ◽

Vein Cannulation

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Real-Time Ultrasound-Guided Subclavian Vein Cannulation in Intensive Care Patients

Journal of the Intensive Care Society ◽

10.1177/175114371301400115 ◽

2013 ◽

Vol 14 (1) ◽

pp. 79-81

Author(s):

Nader Ibrahim ◽

Rajnish Saha

Keyword(s):

Intensive Care ◽

Real Time ◽

Subclavian Vein ◽

Complication Rates ◽

Ultrasound Guided ◽

Level Of Evidence ◽

Intensive Care Patients ◽

Vein Cannulation ◽

Lower Complication

Real-time ultrasound-guided subclavian vein cannulation in intensive care patients has higher success and lower complication rates compared to the traditional landmark method. Level of evidence: 1B (RCT with narrow CIs)

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