To evaluate the safety and efficacy of micropuncture® technique with a 21G needle in an ICU setting for placement of Internal jugular lines.
Retrospective chart analysis was from sept 04 to april 05 on line placement that was done in the medical ICU of 2 tertiary care hospitals. All the lines that were placed under ultrasound guidance and with the use of micropuncture® technique (Cook)® in the internal jugular vein were evaluated . During this time 35 central lines were placed using this technique.All the lines were placed using real time ultrasound i.e the tip of the needle was seen approaching and entering the internal jugular vein.The end points that were measured were failure to place a central line in the first attempt, mechanical complications including but not limited to pneumothorax, carotid artery puncture, brachial plexus injury. Attempt was defined as need for another operator to try the central venous line. All the lines were placed in emergent and semi emergent situations. However none of the lines were placed during the ACLS protocol.
35 cvl lines were placed during this period using the micropuncture® technique and ultrasound guidance. The success rate was 100%. There were no mechanical complications associated with these line placements.
Micropuncture technique with a smaller gauge needle may be associated with high success rate of cannulation and lesser number of mechanical complications for cannulation of the internal jugular in a medical ICU.
Fine needle may be most suitable for real time ultrasound guided line placement.Ultrasound guidence is shown to be associated with high rate of sucess and less number of complications. Using the micropuncture technique or a finer needle 21G may still reduce the number of mechanical complications in the ICU.However appropriate training and experience is needed for the house staff and the fellows.
Hrushikesh Vaidya, None.