Ultrasound guidance increases the safety and ease of insertion of central venous catheters in patients undergoing elective procedures
Abstract
Objective: To determine the advantages of ultrasound guided central venous catheter insertion over anatomical land mark techniqueregarding ease of insertion and safety.
INTRODUCTION
Central Venous Catheterization (CVC) is a relatively common procedure to obtain central venous access for multiple purposes. Some of its uses include providing parenteral nutrition to patients, treatment of intravascular volume depletion, monitoring for hemodynamics, intravenous access (IV) during cardiopulmonary arrest, hemodialysis, difficult peripheral intravenous access and long-term Intravenous access for medications such as antibiotics.1,2 The placement of CVC is a blind procedure making it risky and leads to many complications. The risk is enhanced by a number of factors such as obesity, site of attempted access, operator experience, and associated comorbids such as coagulopathy.1 The anatomical landmark technique has traditionally been used for CVC. In order to decrease complications, ultrasound guidance was introduced. Initialstudies have proven that ultrasound guidance can not only improve the rate of success but also decrease repeated attempts for obtaining access to Internal Jugular Vein (IJV), thus leading to reduced rate of complications.1
The use of IJV for cannulation is favored because of its likely better anatomical location as well as the diameter when patients are placed in Trendelenburg position. One of the most common complications of IJV cannulation is the puncture of the internal carotid artery because of its closeness to the IJV.3,4
The advantages of ultrasound guidance include detection of anatomical variations, exact location of the vessel, avoidance of veins with pre-existing thrombosis and thus add to ease in the catheter placement. This technique has now overtaken the previously used blind technique for central venous access due to multiple benefits.3
In Pakistan, use of ultrasound guidance is very limited for the insertion of CVC. No significant local data exists to justify its routine use. Hence this study was designed to document our experience and to encourage its use in IJV cannulation to make it a routine practice.
