Transitioning from anatomic landmarks to ultrasound guided central venous catheterizations: guidelines applied to clinical practice

2017 ◽  
Vol 18 (4) ◽  
pp. 328-333 ◽  
Author(s):  
Rodrigo Oom ◽  
Rui Casaca ◽  
Rita Barroca ◽  
Sara Carvalhal ◽  
Catarina Santos ◽  
...  
Keyword(s):  
Ultrasound Guidance ◽  
Venous Catheter ◽  
High Volume ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Anatomic Landmarks ◽  
Effective Technique ◽  
Oncological Center ◽  
Landmark Technique ◽  
Prospective Database

Introduction Centrally inserted central catheter (CICC) insertion is a commonly performed procedure that may give rise to different complications. Despite the suggestion of guidelines to use ultrasound guidance (USG) for vascular access, not all centers use it systematically. The aim of this study is to illustrate the experience with ultrasound in CICC placement at a high-volume oncological center, in a country where the landmark technique is standard. Methods Retrospective analysis of a prospective database was performed on CICC placement under USG in the Central Venous Catheter Unit of Instituto Português de Oncologia de Lisboa Francisco Gentil, from 2012 to 2015. Results Three thousand five hundred and seventy-two procedures were recorded. From 2728 CICC placements, 1187 (43.5%) were done using USG. The majority of CICC placements were successful without immediate complications (96.1%). In 55 cases (4.6%), more than three attempts were necessary to puncture the vein. Pneumothorax occurred in 5 cases (0.4%) and arterial puncture was registered in 41 cases (3.5%). An increasing use of USG for placing CICCs was planned and observed over the years and, in the last year of the study, 67.3% of the CICC placements were with USG. Conclusions CICC placement with USG is a safe and effective technique. Despite some resistance that is observed, these results support that it is worth following the guidelines that advocate the use of the USG in the placement of CICC.

scholarly journals THE SUCCESS OF ULTRASOUND GUIDED INSERTION OF CENTRAL VENOUS CATHETER VERSUS LANDMARK TECHNIQUE

2021 ◽  
Vol 71 (1) ◽  
Author(s):  
Bilal Munir ◽  
Fahim Ullah Naz ◽  
Salman Saleem ◽  
Amna Khalid ◽  
Adnan Aqil Khan ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Ultrasound Guidance ◽  
Venous Catheter ◽  
Military Hospital ◽  
Primary Study ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Group A ◽  
Group B ◽  
Landmark Technique

Objective: Central venous catheterization is an important skill for doctors working in the departments ofmedicine, surgery, critical care, anesthesiology, and emergency. The Agency for Healthcare Research and Quality, USA named ultrasound guidance of central venous catheter placement as one of 11 most underutilized practices that can enhance patient safety with greatest strength of evidence to provide clear opportunities for safety improvement. In this study, we compare the success of ultrasound-guided insertion of central venous catheter versus landmark technique. Study Design: Randomized controlled clinical trial. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from Jul to Dec 2016.Methodology: One hundred twenty patients admitted in its wards and undergone CVC were included. Patientswere divided into group A & group B containing 60 patients each. In ‘group A’ CVC was done with ultrasoundassistance while in ‘group B’ CVC was done with landmark technique. The primary study outcome was No. ofattempts at which CVC was done. Results: In this study, 120 patients were enrolled. There was no difference in demographic data comparison.Success rate was found to be 28 (46.67%) in-group A while 16 (26.67%) in-group B with the p-value of 0.042 which is significant. Conclusion: We concluded that CVC with ultrasound guidance is more successful than landmark technique.

scholarly journals Unusual Complications of Ultrasound Guided Central Venous Cannulation

2019 ◽  
Author(s):  
Sonu Sama ◽  
Sanjay Agarwal ◽  
Vijay Adabala ◽  
Michael Leonard Anthony
Keyword(s):  
Continuous Monitoring ◽  
Ultrasound Guidance ◽  
Venous Catheter ◽  
Venous Cannulation ◽  
Central Venous Cannulation ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Common Procedure ◽  
Open Surgical Procedure ◽  
Landmark Technique

Central venous catheter (CVC) insertion is a common procedure in operation theaters and intensive care units (ICU). The procedure is performed through anatomical landmark technique, open surgical procedure, and ultrasound-assisted insertion. In the 1990s, ultrasound guidance of CVC insertion has been advocated as a means to reduce mechanical complications and placement failures compared with the landmark technique. Still CVC complications can be related to insertion, indwelling, or extraction. There is a need for continuous monitoring to avoid possible risk factors so as to minimize the morbidity and mortality.

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

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

scholarly journals Ultrasound-Guided Subclavian Vein Cannulation in Neonate via Supraclavicular Approach

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Onur Balaban ◽  
Tayfun Aydın
Keyword(s):  
Subclavian Vein ◽  
Ultrasound Guidance ◽  
Jugular Vein ◽  
Venous Cannulation ◽  
Central Venous Cannulation ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Supraclavicular Approach ◽  
Vein Cannulation ◽  
Landmark Technique

Central venous cannulation of infants may be challenging. Ultrasonography is recommended and has been found superior to classic landmark technique in pediatric central venous cannulation. The cannulation of the subclavian vein using supraclavicular approach under real-time ultrasound guidance is a novel technique. It may have advantages over ultrasound-guided jugular vein cannulation in specific patients. We report a case of 3200-gram 20-day-old anencephalic neonate who had a diffuse generalized edema. The neonate was cannulated successfully via subclavian vein using supraclavicular approach under ultrasound guidance.

scholarly journals Effect of ultrasound-guided central venous catheter insertion on the incidence of catheter-related bloodstream infections and mechanical complications

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Osamu Imataki ◽  
Mami Shimatani ◽  
Yukiko Ohue ◽  
Makiko Uemura
Keyword(s):  
Ultrasound Guidance ◽  
Hematological Malignancies ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Gram Positive ◽  
Indwelling Catheter ◽  
Early Term ◽  
Mechanical Complications

Abstract Background Central venous catheters (CVCs) are necessary for critically ill patients, including those with hematological malignancies. However, CVC insertion is associated with inevitable risks for various adverse events. Whether ultrasound guidance decreases the risk of catheter-related infection remains unclear. Methods We observed 395 consecutive CVC insertions between April 2009 and January 2013 in our hematological oncology unit. Because the routine use of ultrasound guidance upon CVC insertion was adopted based on our hospital guidelines implemented after 2012, the research period was divided into before December 2011 (early term) and after January 2012 (late term). Results Underlying diseases included hematological malignancies and immunological disorders. In total, 235 and 160 cases were included in the early- and late term groups, respectively. The median insertion duration was 26 days (range, 2–126 days) and 18 days (range, 2–104 days) in the early- and late term groups, respectively. The internal jugular, subclavian, and femoral veins were the sites of 22.6, 40.2, and 25.7% of the insertions in the early term group and 32.3, 16.9, and 25.4% of the insertions in the late term group, respectively. The frequency of catheter-related bloodstream infection (CRBSI) was 1.98/1000 catheter days and 2.17/1000 catheter days in the early- and late term groups, respectively. In the subgroup analysis, the detected causative pathogens of CRBSI did not differ between the two term groups; gram-positive cocci, gram-positive bacilli, and gram-negative bacilli were the causative pathogens in 68.9, 11.5, and 14.8% of the cases in the early term group and in 68.2, 11.4, and 18.2% of the cases in the late term group, respectively. In the multivariate analysis to determine the risk of CRBSI, only age was detected as an independent contributing factor; the indwelling catheter duration was detected as a marginal factor. A significant reduction in mechanical complications was associated with the use of ultrasound guidance. Conclusions Ultrasound-guided CVC insertion did not decrease the incidence of CRBSI. The only identified risk factor for CRBSI was age in our cohort. However, we found that the introduction of ultrasound-guided insertion triggered an overall change in safety management with or without the physicians’ intent.

scholarly journals Central Venous Catheter Insertion: A Scoring System for Evaluation of Both the Procedure and the Operator (CVCI Score/Gaber Score)

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Sayed Gaber ◽  
Ahmed Yehia ◽  
Beshoy Nabil ◽  
Ahmed Samir
Keyword(s):  
Scoring System ◽  
Ultrasound Guidance ◽  
Venous Catheter ◽  
Central Venous ◽  
Ultrasound Technique ◽  
Group A ◽  
Group B ◽  
Landmark Technique ◽  
Ultrasound Group ◽  
New Scoring

Introduction. Currently, there is no method to assess the performance while inserting a central venous catheter. We suggest a new scoring system for evaluation of both the technique as well as the operator, and then we applied it for the comparison between the landmark and ultrasound techniques to assess its validity. Methods. Four hundred patients were divided into two equal groups: group (A): internal jugular vein (IJV) and group (B): subclavian vein (SV). The landmark technique and the ultrasound guidance were used equally (100 patients for each) in both groups. Results. In group (A), 20% of patients in the landmark group achieved score 4, while 82% of patients in the ultrasound group achieved the same score. This suggests that the ultrasound technique for catheterization of IJV decreased overall complications and improved the success rate. In group (B), there were 70% of patients in the landmark group who achieved score 5, while 49% of patients in the ultrasound group achieved the same score which proposes that the landmark technique might be deceptively better than the ultrasound technique for catheterization of SV. This could be because the time required for catheterization of SV by the ultrasound technique was longer than that in the landmark technique. Overall complications of 15% with the landmark technique vs. 2% with ultrasound guidance in this group of patients are not only statistically significant but also increase morbidity and mortality with a highly invasive procedure. Complications and their incidences are by far more significant than seconds of time. Our results suggest that the ultrasound technique could decrease the incidence of overall complications, but it is time-consuming in group (B). These results support the validity of our new scoring system. Conclusion. We suggest a new scoring system for CVC insertion that can be used for evaluation of both the technique and the operator. It can evaluate the performance of junior staff and follow their progress. It can be applied in the medical and critical care practice as well as the quality management privileges and protocols.

scholarly journals Comparative Analysis of Ultrasound Guided Central Venous Catheterization Compared to Blind Catheterization

PRILOZI ◽  
2017 ◽  
Vol 38 (2) ◽  
pp. 107-114 ◽  
Author(s):  
Darko Sazdov ◽  
Marija Jovanovski Srceva ◽  
Zorka Nikolova Todorova
Keyword(s):  
Real Time ◽  
Complication Rate ◽  
Ultrasound Guidance ◽  
Central Venous Catheterization ◽  
Femoral Vein ◽  
Venous Catheter ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Venous Catheterization ◽  
A Prospective Study

Abstract Introduction: Central venous catheterization is performed by the landmark method and ultrasound guided method. The purpose of the study was to compare the success, average number of attempts, average time to return of blood, and complication rate between the two methods. Material and Methods: This was a prospective study done in the Intensive Care Unit of the Acibadem Sistina Clinical Hospital, in Skopje. There were 400 patients in need of central venous catheter and they were prospectively randomized in two groups. The patients randomized in the examined-ultrasound group underwent real-time ultrasound-guided catheterization and the patients randomized in the control-landmark group were catheterized using the landmark method. Internal Jugular, Subclavian and Femoral vein were catheterized in both groups. The Overall success, success on the first attempt, time to the return of blood, number of attempts and complications at the moment of catheterization such as arterial puncture, pneumothorax and hematoma formation were the main outcome measures. Results: The catheterization using the landmark method was successful in 90.5% of patients, 60.5% of which during the first attempt. The cannulation using real-time ultrasound guidance was successful in 98% of patients with a first pass success of 77%. The complication rate with the landmark method was 14.5% versus 4% with real-time ultrasound guidance p<0.05(p=0.0008). Conclusion: Real-time ultrasound guidance improves success, decreases number of attempts, decreases average time to the return of blood and reduces mechanical complications rate.

Ultrasound-guided external jugular and femoral arterial cannulation for juvenile swine

2021 ◽  
pp. 002367722110136
Author(s):  
Travis W Murphy ◽  
Robert Cueto ◽  
Jiepei Zhu ◽  
Bruce Spiess ◽  
Laura B. Eurell ◽  
...  
Keyword(s):  
Ultrasound Guidance ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Seldinger Technique ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Arterial Access ◽  
Single Lumen ◽  
Invasive Techniques

Central venous and arterial access through minimally invasive techniques has been described in adult pigs. This article demonstrates success in juvenile animals. Using ultrasound guidance and the modified Seldinger technique, 5 Fr/15 cm single-lumen central venous catheters and 20 Ga 4.5 cm femoral arterial catheters were placed in six Yorkshire cross-bred swine. All six cases had no loss of venous catheter patency or infection during the 96-hour follow-up period. Arterial catheters remained patent, and no significant bleeding was noted after removal.

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