Vikrant Ghode1, Naresh Dhawan2, R M Sharma3. 1. Graded Specialist (Anaesthesiology), Command Hospital (Western Command), C/o 56 APO, India. 2. Senior Adviser (Anaesthesia) & Cardiac Anaesthesiologist, Army Hospital (R & R), New Delhi, India. 3. Consultant & HOD (Anaesthesia) & Critical Care, Army Hospital R & R, New Delhi, India.
Abstract
BACKGROUND: Real-time ultrasound (US) in central venous catheterization is superior to pre-procedure US. However, ensuring real-time US into routine practice is impeded by its perceived expense and difficulty. This expertise requires hand-eye coordination and learning curve. Moreover, availability of multiple US machines and probes for multiple operation theatres may not be possible even at the tertiary level care set-up. Currently, pre-procedure US and landmark methods are most widely used. We investigated both the techniques with application of skin markings in the pre-procedure group to ascertain efficacy and safety with a view to incorporate pre-procedure US in our practice. METHODS: In this randomized study, we investigated 66 patients. Thirty-three patients in the pre-procedure ultrasound group and 33 patients in the landmark group were included for right internal jugular vein (RIJV) cannulation. We recorded the first needle pass success rate, cannulation time and complications. RESULTS: Pre-procedure US was associated with more successful attempts, shorter cannulation times and less complications. Under pre-procedure US, 75.76% of first attempts were successful with a cannulation time of 50 (25-180) seconds. Under landmark technique, 27.27% of first attempts were successful with a cannulation time of 85 (20-200) seconds. First puncture success rates were higher in pre-procedure US than landmark technique, 66.67% vs 27.27%, respectively. CONCLUSION: Pre-procedure US for RIJV catheterization is safer, quicker and superior to landmark technique.
BACKGROUND: Real-time ultrasound (US) in central venous catheterization is superior to pre-procedure US. However, ensuring real-time US into routine practice is impeded by its perceived expense and difficulty. This expertise requires hand-eye coordination and learning curve. Moreover, availability of multiple US machines and probes for multiple operation theatres may not be possible even at the tertiary level care set-up. Currently, pre-procedure US and landmark methods are most widely used. We investigated both the techniques with application of skin markings in the pre-procedure group to ascertain efficacy and safety with a view to incorporate pre-procedure US in our practice. METHODS: In this randomized study, we investigated 66 patients. Thirty-three patients in the pre-procedure ultrasound group and 33 patients in the landmark group were included for right internal jugular vein (RIJV) cannulation. We recorded the first needle pass success rate, cannulation time and complications. RESULTS: Pre-procedure US was associated with more successful attempts, shorter cannulation times and less complications. Under pre-procedure US, 75.76% of first attempts were successful with a cannulation time of 50 (25-180) seconds. Under landmark technique, 27.27% of first attempts were successful with a cannulation time of 85 (20-200) seconds. First puncture success rates were higher in pre-procedure US than landmark technique, 66.67% vs 27.27%, respectively. CONCLUSION: Pre-procedure US for RIJV catheterization is safer, quicker and superior to landmark technique.
Authors: D L Mallory; W T McGee; T H Shawker; M Brenner; K R Bailey; R G Evans; M M Parker; J C Farmer; J E Parillo Journal: Chest Date: 1990-07 Impact factor: 9.410
Authors: Thanaporn Lorchirachoonkul; Lian Kah Ti; Shivani Manohara; Soh Teng Lye; Sue-Anne Tan; Liang Shen; Dave Song Chua Kang Journal: Singapore Med J Date: 2012-05 Impact factor: 1.858