Ultrasound (US) guidance for the placement of central venous catheters (CVC) has been shown to reduce the risk of arterial puncture and number of sticks required, but has not clearly reduced the major complications of hemorrhage and pneumothorax, especially when conducted by a skilled operator. We performed this study to evaluate if the availability of ultrasound guidance for line placement by an experienced operator resulted in the reduction of the major complications of pneumothorax or hemorrhage.
All CVC placements 6 months prior (group A) and 6 months after (group B) the introduction of ultrasound vascular visualization in our ICU were evaluated. The landmark technique was used before the ultrasound was available. Once, available, US was used at the discretion of the operator. Charts were evaluated for patient information, diagnosis, coagulation parameters and post-procedure pneumothoraces and hemorrhage. All lines were placed by certified operators (physicians with more than 5 successfully placed lines) and blood products were used to reverse coagulopathies pre-procedure.
The placement of 287 central lines were analyzed in the study. In group A, 170 were placed by the landmark technique, 117 by IJ route and 53 by SC route. In group B, 118 lines were placed, 92 by IJ route and 26 by SC. Diagnoses and pre-procedure coagulopathies were similar among both groups. One patient in each group developed clinically significant bleeding. Two (1.2%) patients in group A developed post-procedure pneumothoraces (one placed at the IJ site another at the SC site). There were no pneumothoraces in Group B.
There was no observed difference in post-procedure bleeding during central line placement using the landmark technique versus using ultrasound guidance. However, fewer pneumothoraces were observed (0% versus 1.2%) after introduction and availability of the ultrasound technique versus utilization of the landmark technique.
The incidence of pneumothoraces, even by experienced operators, could be reduced by wider utilization of ultrasound guidance for line placement. This may be due to increased utilization of the IJ route.
Arseniy Tsapenko, No Financial Disclosure Information; No Product/Research Disclosure Information