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.
To analyze safety and effectiveness of CVC cannulation by ultrasound guided (USG)
technique in critical care setting.
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.
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.
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.