The 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. Dimitrios Karakitsos, from the Intensive Care Unit of the General State Hospital of Athens in Greece, and colleagues from other institutions in 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 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 haematoma, and no cases of haemothorax or pneumothorax, were reported following ultrasound-guided catheterisation. By contrast, haematoma occurred in 8.4% of patients who had a standard catheterisation. Haemothorax occurred in 1.7% and carotid artery puncture occurred in 10.6% of the patients undergoing standard catheterisation. The 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."
COMPAMED.de; Source: BioMed Central