title: Insertion of internal jugular temporary hemodialysis cannulae by direct ultrasound guidance--a prospective comparison of experienced and inexperienced operators.
abstract: OBJECTIVE
  Previous studies have shown that inexperienced operators have a lower success rate than experienced operators for insertion of internal jugular cannulae using the anatomical landmark technique. The object of this study was to determine the rate of successful insertion, incidence of immediate complications and incidence of infection for temporary hemodialysis cannulae inserted under ultrasound guidance by experienced and inexperienced operators.
  
  
  METHODS
  The reason for insertion, patient age, reason for failed insertion, immediate complications, duration of cannula survival and reason for removal were recorded prospectively for 107 attempted cannulations by 7 operators in 72 subjects with renal failure. Operators were defined as "experienced" (more than 3 years postgraduate clinical experience and more than 25 previous central vein cannulae inserted) or "inexperienced" (less than 3 years postgraduate clinical experience and less than 3 previous central vein cannulae inserted). Rates of successful cannulation and incidence of complications were compared for experienced and inexperienced operators. Cannula survival without infection was analysed by Kaplan-Meier survival for experienced and inexperienced operators.
  
  
  RESULTS
  The overall success rate of cannula insertion at first site was 103/107 (96.3%) with no difference between experienced and inexperienced operators (56/58 vs. 47/49). 103 internal jugular temporary haemodialysis cannulae were inserted into 72 subjects. The only immediate complication was incorrect positioning of the cannula in 6 cases requiring manipulation. The median survival of hemodialysis cannulae was 14 days (range 1-111). 64.1% cannulae functioned for as long as required. Of the remainder, 33/36 were removed because of presumed cannula related infection. There was no difference in the median duration of cannula survival between experienced and inexperienced operators (15 days versus 12 days; Mann-Whitney point estimate = -1.00; 95% confidence interval -6.00, 3.00). p = 0.66) or in the probability of cannula survival without infection by Kaplan Meier analysis.
  
  
  CONCLUSIONS
  We conclude that ultrasound guided temporary haemodialysis cannulation is a safe procedure with a high rate of success, the success rate for inexperienced operators is much higher than previous studies of cannulation using the anatomical landmark technique and the rate of cannula removal due to infection is not influenced by operator experience.
authors.affiliation: Renal Unit, Stobhill Hospital, Glasgow, UK.
authors.forename: C C
authors.initials: CC
authors.lastname: Geddes
authors.forename: D
authors.initials: D
authors.lastname: Walbaum
authors.forename: J G
authors.initials: JG
authors.lastname: Fox
authors.forename: R A
authors.initials: RA
authors.lastname: Mactier
mesh_terms: D002405:Catheterization, Central Venous / Q000379:methods / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D013997:Time Factors; D014463:Ultrasonography / Q000379:methods