Jay A Requarth1. 1. Section of Vascular and Interventional Radiology, Department of Radiologic Sciences, Wake Forest University Baptist Medical Center, Medical Center Blvd, Winston Salem, NC 27157, USA. jrequart@wfubmc.edu
Abstract
BACKGROUND: The use of real-time two-dimensional B-mode ultrasound (RTUS)-aided central venous access device (CVAD) insertion has been recommended by health-care agencies, but a realistic failure rate for bedside attempts is unknown. METHODS: The failure rate of RTUS-aided CVAD insertion is estimated using data from adult inpatients and outpatients referred to a tertiary referral radiology department for a new CVAD insertion during the 2.5-year period ending February 29, 2008. Cannulation failure, complications, and additional fluoroscopic interventions per central vein cannulation attempt and per patient encounter were retrospectively collected and evaluated. RESULTS: Of the 2456 consecutive patient encounters, the index central vein cannulation failure rate using only RTUS and fluoroscopy was 4.8%; ultimate failure rate was 0.3%. The procedural mortality rate was 0.04%. If the index upper-body central vein cannulation failed, an ipsilateral upper-body attempt through a different central vein failed in 63.6%, whereas a contralateral upper-body attempt failed in 26.7% (p = 0.11) and a common femoral vein attempt failed in 11.5% (p = 0.0039). CONCLUSIONS: The minimum bedside failure rate of RTUS-aided CVAD insertion is 4.8% for the index central vein cannulated. The ultimate failure rate of 0.3% and the mortality rate of 0.04% are due to RTUS, fluoroscopy, and the additional equipment available in an IR suite. If the upper-body index central vein cannulation fails, cannulation of the common femoral vein is more likely to succeed than additional attempts in other ipsilateral upper-body central veins.
BACKGROUND: The use of real-time two-dimensional B-mode ultrasound (RTUS)-aided central venous access device (CVAD) insertion has been recommended by health-care agencies, but a realistic failure rate for bedside attempts is unknown. METHODS: The failure rate of RTUS-aided CVAD insertion is estimated using data from adult inpatients and outpatients referred to a tertiary referral radiology department for a new CVAD insertion during the 2.5-year period ending February 29, 2008. Cannulation failure, complications, and additional fluoroscopic interventions per central vein cannulation attempt and per patient encounter were retrospectively collected and evaluated. RESULTS: Of the 2456 consecutive patient encounters, the index central vein cannulation failure rate using only RTUS and fluoroscopy was 4.8%; ultimate failure rate was 0.3%. The procedural mortality rate was 0.04%. If the index upper-body central vein cannulation failed, an ipsilateral upper-body attempt through a different central vein failed in 63.6%, whereas a contralateral upper-body attempt failed in 26.7% (p = 0.11) and a common femoral vein attempt failed in 11.5% (p = 0.0039). CONCLUSIONS: The minimum bedside failure rate of RTUS-aided CVAD insertion is 4.8% for the index central vein cannulated. The ultimate failure rate of 0.3% and the mortality rate of 0.04% are due to RTUS, fluoroscopy, and the additional equipment available in an IR suite. If the upper-body index central vein cannulation fails, cannulation of the common femoral vein is more likely to succeed than additional attempts in other ipsilateral upper-body central veins.
Authors: M Tseng; D Sadler; J Wong; K R Teague; D C Schemmer; J C Saliken; B So; R R Gray Journal: Can Assoc Radiol J Date: 2001-12 Impact factor: 2.248