Ultrasound-guided central venous catheterisation is easier, quicker and safer than the traditional method using landmarks, and should be the method of choice when treating critical care patients.
In an article published in the journal Critical Care, researchers report the results of a prospective randomised controlled trial comparing the use of ultrasound to guide catheterisation to the traditional method using physical landmarks. The researchers report a success rate of 100% for ultrasound-guided catheterisation of the internal jugular vein. They show that the method is less likely to result in blood stream infections or complications, such as puncture of an artery, than the normal catheterisation procedure.
Dimitrios Karakitsos, from the Intensive Care Unit of the General State Hospital of Athens in Greece (the echolabicu team), and colleagues from other institutions in Greece, The Netherlands and the USA, compared the outcome of internal jugular vein catheterisation in 450 patients for whom the procedure was guided by ultrasound and in 450 patients for whom physical landmarks were used for guidance. During the ultrasound-guided catheterisation, the physician is helped by ultrasound-generated, real-time, two-dimensional images of the jugular vein. The patients were matched between the two groups for age, gender, BMI and risk factors for complications following catheterisation.
Karakitsos et al.'s results show an overall success rate of 100% for ultrasound-guided catheterisation and a 94% success rate for the standard procedure. Very few cases of carotid puncture or hematoma, and no cases of hemothorax or pneumothorax, were reported following ultrasound-guided catheterisation. By contrast, hematoma occurred in 8.4% of patients who had a standard catheterization. Hemothorax occurred in 1.7% and carotid artery puncture occurred in 10.6% of the patients undergoing standard catheterisation. Karakitsos et al.'s results also show that 16% of patients who received the standard procedure had a central venous catheter associated blood stream infection, compared to 10.4% of patients who had the ultrasound-guided procedure. The time taken to insert the catheter and the number of attempts were also greatly reduced for patients who received the ultrasound-guided procedure.
The authors conclude: "Ultrasound imaging is a readily available technology and may be employed by inexperienced operators to facilitate the placement of a central venous catheter as well as by experienced operators in order to improve the safety of the procedure."
In an accompanying commentary, Andrew Bodenham from Leeds General Infirmary in the UK adds: "In the past, it was possible to defend clinicians not using ultrasound on the basis that it was not yet routine practice but I think this position will become increasingly untenable in the future."
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