Central venous cannulation under ultrasonographic and fluoroscopic navigation – 2 year experience
Authors:
J. Hájek 1,3; V. Chovanec 1,2; P. Chytrý 1; I. Merglová 1; P. Hanousková 1; M. Pilař 1; S. Kašová 1; J. Lerchová 1; A. Krajina 2
Authors place of work:
Pardubická krajská nemocnice, a. s., Pardubice
1; Radiologická klinika LF UK a FN, Hradec Králové
2; Fakulta zdravotnických studií, Univerzita Pardubice, Pardubice
3
Published in the journal:
Rozhl. Chir., 2012, roč. 91, č. 12, s. 660-665.
Category:
Original articles
Summary
Introduction:
The aim of our study was to evaluate the influence of ultrasonographic and fluoroscopic navigation on the rate of procedural and early complications during central venous cannulation.
Material and methods:
We retrospectively evaluated procedural and early complications in patients who had undergone central venous cannulation under sonographic and fluoroscopic control within a two year period (from January 2010 to December 2011). We studied procedural and early complications (within 24 hours after the procedure). We summarized all cases of pneumothorax, haemothorax and haematoma of soft tissue larger than 5 cm in long axis, and other severe complications e.g. ardiac arrhythmias or hypotension. The set of patients indicated for central venous cannulation included mainly oncological patients who were implanted central venous port systems, and a small group of patients who were cannulated either at the intensive care unit (ICU) or at the department of anesthesiology after unsuccessful blind cannulation. There were three patients cannulated because of transjugular liver biopsy.
Results:
We cannulated 165 patients under sonographic control within two years. There were 66 men, the mean age of 58.6 years (20–82) and 99 women, the mean age of 58.3 years (36– 94). We cannulated internal jugular vein 148 times and subclavian vein 17 times. The primary technical success was 100% in our study group. Totally, we had 6 complications (3.6%). Immediatelly after the procedure we observed two pneumothoraxes (1.2%) which did not require chest drainage. We punctured artery wall three times, but without haematoma developement, and after a ten-minute commpression, all procedures were successfully finished. We had serious vagal reaction during the cannulation in one patient. We had no fatal procedural complication in our group. There are significantly fewer complications using jugular approach compared to subclavian one.
Conclusion:
We conclude that the ultrasonographic central venous cannulation is a very safe method with a low risk of procedural and early complications. There were significantly fewer complications in case of jugular cannulation compared to subclavian approach in our group of patients. Ultrasonographically navigated central venous cannulation should be used more fequently in emergency medicine as well as in case of non-acute central venous cannulation performed a tan intensive care unit or by anesthesiologists.
Key words:
central venous access – ultrasonographic navigation – cannulation, fluoroscopy
Zdroje
1. ACS Committee on Periprocedural Care. Revised statement on recommendations for use of real-time ultrasound guidance for placement of central venous catheters. Bull Am Coll Surg 2011;96(2):36–7.
2. Atkinson A, Boyle A, Campbell-Hewson G. Should ultrasound guidance be used for central venous catheterisation in the emergency department? Emerg Med J 2005;22:158–164.
3. Hind D, Calvert N, McWilliams R et al. Ultrasonic location devices for central venous cannulation: meta-analysis. BMJ 2003;327(7411):361.
4. Fragou M, Gravvanis A, Dimitriou V et al. Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patient: A prospective randomized study. Crit Care Med 2011;39:1607–12.
5. Milling TJ, Rose J, Briggs WM et al. Randomised, 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 2005; 33(8):1764–9.
6. Lamperti M, Bodenham AR Pittiruti M et al. International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Med 2012;38:1105–1117.
7. Rupp SM, Apfelbaum JL, Blitt C. Practice guidelines for central venous acces: a report by the American Society of Anesthesiologist Task Force on Central Venous Access. Anesthesiology 2012;116:539–573.
8. Seldinger SI. Catheter replacement of the needle in percutaneous arteriography: a new technique. Acta Radiol 1953;39:368–376.
9. Yonei A, Nonoue T, Sari A. Real time ultrasonic guidance for percutaneous puncture of the internal jugular vein. Anesthesiology 1986;64:830–831.
10. Gibbs FJ, Murphy MC. Ultrasound guidance for central venous catheter placement. Hospital Physician 2006;23–31.
11. Stefanidis K, Pentilas N, Dimopoulos S et al. Echogenic technology improves cannula visibility during ultrasound-guided internal jugular vein catheterization via a transverse approach. Crit Care Res Pract 2012;2012:306182. Epub 2012 May 10.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2012 Číslo 12
- Spasmolytic Effect of Metamizole
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole in perioperative treatment in children under 14 years – results of a questionnaire survey from practice
Najčítanejšie v tomto čísle
- STARR surgery in the treatment of rectocele and rectal intussusception
- Upside down stomach
- Classification of surgical complications: analysis of the group of consecutive patients
- Lung pneumatocele in adult patient – case report