An Ultrasound Guided Technique of Central Venous Catheterization versus Anatomical Landmark Guided Technique in Medical Intensive Care Patients

Abstract

Background: Central venous catheterization (CVC) is an important procedure in the practice of emergency medicine. Insertion of CVC is amongst the most frequently performed invasive procedures in ICU. In severely ill and long-stay patients, inserted CVCs enable relatively safe and painless application of parenteral nutrition, long-term antibiotics, chemotherapy, intravenous fluids, and blood components and are also used for repetitive blood sampling. Furthermore, CVCs are used for invasive hemodynamic monitoring, hemodialysis, plasmapheresis and in case of shortage of a peripheral access. With the increasing availability of bedside ultrasound, emergency physicians have begun to incorporate this new technology to reduce error and improve patient care. Objective: To compare the outcome of an ultrasound guided technique versus an anatomical landmark guided technique for central venous catheterization. Patients and methods: The present study was performed on one hundred patients of both sexes; the study was conducted at El-Hussein University Hospital. They were scheduled for insertion of central venous line for various purposes. The patients were assigned into two groups each group formed of fifty patients (n=50). Group (A): Anatomical guided technique for insertion of CVC, Group (B): Ultrasound guided technique for insertion of CVC. Patients with local infection, known vascular abnormalities, untreated coagulopathy (INR more than 1.5, platelets less than 50000/mm 3) and age less than 16 years old were excluded from the study. Results: A total of 100 patients were included. The outcome of each group was recorded regarding success rate, number of attempts and access time in seconds. The use of ultrasound guided central venous catheterization has better outcome and higher-safety in comparison to anatomical landmark-based technique. Ultrasound guidance elevated significantly the success rate of central venous catheterization than anatomical landmark-based technique. In addition, the access time was reduced in a significant trend by using ultrasound guidance. In the same manner the average number of attempts needed for accessing the vein was limited significantly when Ultrasound guidance was applied. The incidence of hematoma formation, arterial puncture and malposition was reduced in a significant trend by using ultrasound guidance in comparison to landmark-based techniques. When comparing ultrasound guidance to anatomical landmark-based guidance we found that all mechanical complications were significantly lower when central venous catheterization was carried out by means of ultrasound guidance. Conclusion: Ultrasound examination of the region of interest offers some additional information compared to clinical examination as Position of the vessel, Patency of the vessel, Size of the vessel and Stenosis or hematoma. The implementation of ultrasound guidance improves success and reduces complication rate during central venous catheterization.