Ultrasonography-Guided Jugular Venous Catheter Insertion for Renal Transplant Recipients Before Renal Transplantation: A Prospective Study

Ultrasound-Guided Central Venous Catheter Placement by Surgical Trainees: A Safe Procedure?

Background

Central venous catheters (CVCs) are widely used to create a temporary or long-term access to the central venous system. A variety of treatments require a functional central venous access, including hemodialysis, administration of drugs, plasmapheresis and parenteral nutrition. The aim of this study was to evaluate the results of CVC placement performed by surgical trainees, according to a strict protocol of ultrasound-guided puncture and fluoroscopy-guided catheter insertion in a large teaching hospital in an outpatient setting.

Methods

Between 1 January 2006 and 31 December 2008, 539 CVCs were placed, of which 486 were primary inserted by surgical trainees. All placements were ultrasound- and fluoroscopy-guided. After every placement operators recorded type of catheter, type of anesthesia, subcutaneous tunneling, technique of insertion and complications.

Results

The study population consisted of 52% males. Access sites of CVCs were the internal jugular vein (91%), subclavian vein (5%) and other veins (3%). Technical success rate was 96.5%. Complication rate was 8.4%, of which 93% were arterial punctures. Pneumothorax occurred in three patients.

Conclusions

CVC placement by surgical trainees is a safe procedure when using a strict protocol of ultrasound-guided vessel puncture and fluoroscopic-guided catheter placement.

Ultrasound guided vascular access: efficacy and safety

Central venous catheterisation and arterial catheterisation are common procedures performed by anaesthetists. Traditionally, the technique of locating surface landmarks and palpation was used to assist in vascular access. The introduction of perioperative ultrasonography in the past decade has dramatically changed this procedure. In the United States and United Kingdom, guidelines have recommended the use of ultrasound guidance to reduce complications and improve success in central venous catheterisation. This article summarises the literature on complication rates, efficacy and safety of ultrasound-guided vascular access procedures and describes a practical method of ultrasound-guided central venous access and arterial catheterisation.