Skip to main content

Advertisement

Log in

Ultrasound-guided central venous cannulation is superior to quick-look ultrasound and landmark methods among inexperienced operators: a prospective randomized study

  • Original Article
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

Quick-look ultrasound with a skin mark (UM) has been frequently used for central vein cannulation. The aim of this study is to compare this method with landmark (LM) and ultrasound-guided (UG) cannulation of jugular and femoral veins by inexperienced operators.

Design

Prospective randomized single-center study.

Setting

A medical intensive care unit (ICU) of a university medical center.

Patients

Patients requiring jugular or femoral central cannula placement.

Intervention

Each inexperienced resident randomly inserted a central venous line using the UM, LM or UG technique.

Measurements and findings

The primary outcome was the success rate, and secondary outcomes were the placement time, number of attempts, mechanical complication rate, and catheter colonization rate. A total of 118 patients were randomly assigned to the three groups. The mean age of patients included in the study was 65 ± 15 years, and the mean Simplified Acute Physiology Score 2 (SAPS2) was 57 ± 20. The success rate was higher in the UG group than in the LM and UM groups (100, 74, and 73 %, respectively; p = 0.01). The total number of mechanical complications was higher in the LM and UM groups than in the UG group (24 and 36 versus 0 %, respectively; p = 0.01). The number of attempts and the access time were higher in the LM group than in the UG group, but not compared with the UM group. No difference in terms of catheter colonization was observed between the three groups.

Conclusions

Ultrasound-guided cannulation of the internal jugular or femoral vein by inexperienced residents appears to be more reliable than the LM or UM methods and was associated with a lower mechanical complication rate among ICU patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Mallory DL, McGee WT, Shawker TH, Brenner M, Bailey KR, Evans RG, Parker MM, Farmer JC, Parillo JE (1990) Ultrasound guidance improves the success rate of internal jugular vein cannulation. A prospective, randomized trial. Chest 98:157–160

    Article  PubMed  CAS  Google Scholar 

  2. Augoustides JG, Horak J, Ochroch AE, Vernick WJ, Gambone AJ, Weiner J, Pinchasik D, Kowalchuk D, Savino JS, Jobes DR (2005) A randomized controlled clinical trial of real-time needle-guided ultrasound for internal jugular venous cannulation in a large university anesthesia department. J Cardiothorac Vasc Anesth 19:310–315

    Article  PubMed  Google Scholar 

  3. Karakitsos D, Labropoulos N, De Groot E, Patrianakos AP, Kouraklis G, Poularas J, Samonis G, Tsoutsos DA, Konstadoulakis MM, Karabinis A (2006) Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care 10:R162

    Article  PubMed  Google Scholar 

  4. Caridi JG, Hawkins IF Jr, Wiechmann BN, Pevarski DJ, Tonkin JC (1998) Sonographic guidance when using the right internal jugular vein for central vein access. AJR Am J Roentgenol 171:1259–1263

    Article  PubMed  CAS  Google Scholar 

  5. Kwon TH, Kim YL, Cho DK (1997) Ultrasound-guided cannulation of the femoral vein for acute haemodialysis access. Nephrol Dial Transplant 12:1009–1012

    Article  PubMed  CAS  Google Scholar 

  6. Hilty WM, Hudson PA, Levitt MA, Hall JB (1997) Real-time ultrasound-guided femoral vein catheterization during cardiopulmonary resuscitation. Ann Emerg Med 29:331–336

    Article  PubMed  CAS  Google Scholar 

  7. Sigaut S, Skhiri A, Stany I, Golmar J, Nivoche Y, Constant I, Murat I, Dahmani S (2009) Ultrasound guided internal jugular vein access in children and infant: a meta-analysis of published studies. Paediatr Anaesth 19:1199–1206

    Article  PubMed  Google Scholar 

  8. Hind D, Calvert N, McWilliams R, Davidson A, Paisley S, Beverley C, Thomas S (2003) Ultrasonic locating devices for central venous cannulation: meta-analysis. BMJ 327:361

    Article  PubMed  Google Scholar 

  9. Troianos CA, Jobes DR, Ellison N (1991) Ultrasound-guided cannulation of the internal jugular vein. A prospective, randomized study. Anesth Analg 72:823–826

    Article  PubMed  CAS  Google Scholar 

  10. Lamperti M, Bodenham AR, Pittiruti M, Blaivas M, Augoustides JG, Elbarbary M, Pirotte T, Karakitsos D, Ledonne J, Doniger S, Scoppettuolo G, Feller-Kopman D, Schummer W, Biffi R, Desruennes E, Melniker LA, Verghese ST (2012) International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Med 38:1105–1117

    Article  PubMed  Google Scholar 

  11. Troianos CA, Hartman GS, Glas KE, Skubas NJ, Eberhardt RT, Walker JD, Reeves ST, Councils on Intraoperative Echocardiography and Vascular Ultrasound of the American Society of Echocardiography; Society of Cardiovascular Anesthesiologists (2011) Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 24:1291–1318

    Article  PubMed  Google Scholar 

  12. American Society of Anesthesiologists Task Force on Central Venous Access, Rupp SM, Apfelbaum JL, Blitt C, Caplan RA, Connis RT, Domino KB, Fleisher LA, Grant S, Mark JB, Morray JP, Nickinovich DG, Tung A (2012) Practice guidelines for central venous access: a report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology 116:539–573

    Article  PubMed  Google Scholar 

  13. National Institute for Clinical Excellence. NICE technology appraisal guidance No. 49: Guidance on the use of ultrasound locating devices for placing central venous catheters. London: NICE, 2002. Available from http://www.nice.org.uk/pdf/ultrasound_49_GUIDANCE.pdf.

  14. McGrattan T, Duffty J, Green JS, O’Donnell N (2008) A survey of the use of ultrasound guidance in internal jugular venous cannulation. Anaesthesia 63:1222–1225

    Article  PubMed  CAS  Google Scholar 

  15. Bailey PL, Glance LG, Eaton MP, Parshall B, McIntosh S (2007) A survey of the use of ultrasound during central venous catheterization. Anesth Analg 104:491–497

    Article  PubMed  Google Scholar 

  16. Balls A, LoVecchio F, Kroeger A, Stapczynski JS, Mulrow M, Drachman D, Central Line Emergency Access Registry Investigators (2010) Ultrasound guidance for central venous catheter placement: results from the Central Line Emergency Access Registry Database. Am J Emerg Med 28:561–567

    Article  PubMed  Google Scholar 

  17. Tovey G, Stokes M (2007) A survey of the use of 2D ultrasound guidance for insertion of central venous catheters by UK consultant paediatric anaesthetists. Eur J Anaesthesiol 24:71–75

    PubMed  CAS  Google Scholar 

  18. Slama M, Novara A, Safavian A, Ossart M, Safar M, Fagon JY (1997) Improvement of internal jugular vein cannulation using an ultrasound-guided technique. Intensive Care Med 23:916–919

    Article  PubMed  CAS  Google Scholar 

  19. Mitre CI, Golea A, Acalovschi I, Mocan T, Caea AM, Ruţă C, Mariana M (2010) Ultrasound-guided external jugular vein cannulation for central venous access by inexperienced trainees. Eur J Anaesthesiol 27:300–303

    Article  PubMed  Google Scholar 

  20. Geddes CC, Walbaum D, Fox JG, Mactier RA (1998) Insertion of internal jugular temporary hemodialysis cannulae by direct ultrasound guidance—a prospective comparison of experienced and inexperienced operators. Clin Nephrol 50:320–325

    PubMed  CAS  Google Scholar 

  21. Kaye AD, Fox CJ, Hymel BJ, Gayle JA, Hawney HA, Bawcom BA, Cotter TD (2011) The importance of training for ultrasound guidance in central vein catheterization. Middle East J Anesthesiol 21:61–66

    PubMed  Google Scholar 

  22. Milling TJ Jr, Rose J, Briggs WM, Birkhahn R, Gaeta TJ, Bove JJ, Melniker LA (2005) Randomized, controlled clinical trial of point-of-care limited ultrasonography assistance of central venous cannulation: the third Sonography Outcomes Assessment Program (SOAP-3) Trial. Crit Care Med 33:1764–1769

    Article  PubMed  Google Scholar 

  23. Hosokawa K, Shime N, Kato Y, Hashimoto S (2007) A randomized trial of ultrasound image-based skin surface marking versus real-time ultrasound-guided internal jugular vein catheterization in infants. Anesthesiology 107:720–724

    Article  PubMed  Google Scholar 

  24. Hayashi H, Amano M (2002) Does ultrasound imaging before puncture facilitate internal jugular vein cannulation? Prospective randomized comparison with landmark-guided puncture in ventilated patients. J Cardiothorac Vasc Anesth 16:572–575

    Article  PubMed  Google Scholar 

  25. Denys BG, Uretsky BF, Reddy PS (1993) Ultrasound-assisted cannulation of the internal jugular vein. A prospective comparison to the external landmark-guided technique. Circulation 87:1557–1562

    Article  PubMed  CAS  Google Scholar 

  26. Randolph AG, Cook DJ, Gonzales CA, Pribble CG (1996) Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med 24:2053–2058

    Article  PubMed  CAS  Google Scholar 

  27. Fragou M, Gravvanis A, Dimitriou V, Papalois A, Kouraklis G, Karabinis A, Saranteas T, Poularas J, Papanikolaou J, Davlouros P, Labropoulos N, Karakitsos D (2011) Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: a prospective randomized study. Crit Care Med 39:1607–1612

    Article  PubMed  Google Scholar 

  28. Bold RJ, Winchester DJ, Madary AR, Gregurich MA, Mansfield PF (1998) Prospective, randomized trial of Doppler-assisted subclavian vein catheterization. Arch Surg 133:1089–1093

    Article  PubMed  CAS  Google Scholar 

  29. Polderman KH, Girbes AJ (2002) Central venous catheter use. Part 1: mechanical complications. Intensive Care Med 28:1–17

    Article  PubMed  Google Scholar 

  30. O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S, Healthcare Infection Control Practices Advisory Committee (HICPAC) (2011) Summary of recommendations: guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 52:1087–1099

    Article  PubMed  Google Scholar 

  31. Stone MB, Moon C, Sutijono D, Blaivas M (2010) Needle tip visualization during ultrasound-guided vascular access: short-axis vs long-axis approach. Am J Emerg Med 28:343–347

    Article  PubMed  Google Scholar 

  32. Moon CH, Blehar D, Shear MA, Uyehara P, Gaspari RJ, Arnold J, Cukor J (2010) Incidence of posterior vessel wall puncture during ultrasound-guided vessel cannulation in a simulated model. Acad Emerg Med 17:1138–1141

    Article  PubMed  Google Scholar 

  33. Chittoodan S, Breen D, O’Donnell BD, Iohom G (2011) Long versus short axis ultrasound guided approach for internal jugular vein cannulation: a prospective randomised controlled trial. Med Ultrason 13:21–25

    PubMed  Google Scholar 

  34. Maizel J, Ammirati C, Slama M (2010) Posterior vessel wall penetration by needles during internal jugular vein central catheter placement using ultrasound guidance: is that a real danger? Crit Care Med 2:735–736

    Article  Google Scholar 

  35. Dodge KL, Lynch CA, Moore CL, Biroscak BJ, Evans LV (2012) Use of ultrasound guidance improves central venous catheter insertion success rates among junior residents. J Ultrasound Med 31:1519–1526

    PubMed  Google Scholar 

Download references

Acknowledgments

We acknowledge Dr. Anthony Saul for his help in the redaction of this article.

Conflicts of interest

Authors have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michel Slama.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Airapetian, N., Maizel, J., Langelle, F. et al. Ultrasound-guided central venous cannulation is superior to quick-look ultrasound and landmark methods among inexperienced operators: a prospective randomized study. Intensive Care Med 39, 1938–1944 (2013). https://doi.org/10.1007/s00134-013-3072-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-013-3072-z

Keywords

Navigation