To evaluate the safety and efficacy of real-time ultrasound guided program for placement of central venous catheters in predominantly medical intensive care unit (ICU) patient population.
Patients who had failed blind traditional anatomic land mark technique or were considered to be potentially high risk for the traditional technique (morbidly obese, severe coagulapathy, on mechanical ventilation) had central venous catheters placed under real-time ultrasound guidance using the Site Rite 3 (BARD) ultrasound unit. Physicians at various training levels (MICU attending physician, critical care fellows, housestaff) performed all procedures under the supervision of medical intensivist. Success rate, major complications, number of attempts, catheter (C) type and indications, anatomic site, and demographics were recorded prospectively.
48 catheters in 36 patients were placed over 7-months period. 43 catheters were placed in MICU. Internal jugular approach was used in 44 procedures and femoral approach in 4 procedures. Catheters were placed successfully in 48/48 procedures (100% success rate). 28 catheter placements (58%) were successful in first attempt. Number of attempts needed for successful placement ranged from 1–3. There was one arterial puncture in one incident and no incident of pneumothorax.CONCLUSIONS: Ultrasound guided central venous catheterization is safe and easy technique and can be used successfully in critically ill high risk patients.
Central venous catheterization using real time ultrasound guidance is underutilized and can be easily taught to physicians in training and can potentially reduce risks and serious complications in the critically ill patients.
A.U. Munir, None.