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      Ultrasound guided technique for central venous catheters cannulation in critical care patients

      , , , , , , , ,

      Intensive Care Medicine Experimental

      Springer International Publishing

      ESICM LIVES 2015

      3-7 October 2015

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          Abstract

          Introduction Central venous catheters (CVC) can help with diagnosis and treatment of the critically ill. CVC cannulation risks arterial puncture and other complications and should be performed in as few attempts as possible. In the past, anatomical landmarks on the body surface were used to find the correct place to insert these catheters, but ultrasound imaging is now available. Objectives To analyze safety and effectiveness of CVC cannulation by ultrasound guided (USG) technique in critical care setting. Methods Prospective and observational study of all CVC cannulated in ICU patients, except those peripherally inserted, during 9 months in a university teaching hospital. Demographic and clinical data as well as variables related to cannulation were collected. Results are expressed as mean ± standard deviation and percentages. Comparisons between variables were performed by Student´s t-test and Pearson´s chi-squared test. Results A total of 175 CVC were cannulated in 118 patients. On the first attempt, USG technique was chosen in 93 CVC (53.1%) being the successful procedure in 107 CVC (61.1%). There were no differences between USG and anatomical landmark technique regarding sex (women 35.9% vs. 38.5%; p = 0.727) or age (66.0 ± 14.3 years vs. 67.3 ± 14.2 years; p = 0.553). According to CVC indication, USG cannulation was chosen mainly for renal replacement therapy (22.6% vs. 9.8%; p = 0.023). Nonetheless, there were no differences regarding haemodinamic management (62.4% vs. 73.0%; p = 0.128), parenteral nutrition (8.6% vs. 3.7%; p = 0.179) and temporary pacemaker (5.4% vs. 11.0%; p = 0.173). USG technique was mainly performed by residents (57.8% vs. 33.3%; p = 0.011), in more severe patients (SOFA 9.0 ± 4.3 vs. 7.3 ± 4.3; p = 0.018), in patients with another CVC 30 days before (36.6% vs. 20.7%; p = 0.021) and if platelets transfusion was needed (10.8% vs. 2.4%; p = 0.030) without differences in local complications (29.0% vs. 32.9%; p = 0.578). In the same way, first attempt successful rate was higher in USG procedure (68.8% vs. 48.8%; p = 0.007) contrary to what happened with the need for technique change (3.2% vs. 20.7%; p < 0.001). Finally, there were no severe complications in both groups. Conclusions In critical care setting, ultrasound guided CVC cannulation is a safe procedure which use is preferred in more severe patients. In the same way, USG technique is related to higher successful rate on the first attempt than conventional procedure.

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          Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization

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            Author and article information

            Conference
            Intensive Care Med Exp
            Intensive Care Med Exp
            Intensive Care Medicine Experimental
            Springer International Publishing (Cham )
            2197-425X
            1 October 2015
            1 October 2015
            December 2015
            : 3
            Issue : Suppl 1 Issue sponsor : The publication charges for this supplement were funded by Intensive Care Medicine Experimental.
            Affiliations
            Intensive Care Unit, Morales Meseguer Hospital, Murcia, Spain
            Article
            217
            10.1186/2197-425X-3-S1-A71
            4797720
            © Soler et al.; 2015

            This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

            ESICM LIVES 2015
            Berlin, Germany
            3-7 October 2015
            Categories
            Poster Presentation
            Custom metadata
            © The Author(s) 2015

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