Ultrasound-guided central venous access.
OBJECTIVE
Real-time ultrasound guidance should increase the success rate and lower the complication rate of central venous access in patients with relative contraindications to having the procedure performed.


METHODS
Prospective case series.


METHODS
A community-based tertiary care hospital.


METHODS
Fifty-two patients were studied. Relative risks to central venous catheter insertion included (1) thrombosis or stenosis of central veins, (2) inherent or acquired anticoagulation abnormalities, (3) inability to assume a supine position, (4) hypovolemia, (5) obesity or altered anatomy, and (6) severe respiratory compromise.


METHODS
Real-time ultrasound evaluation of the proposed vein to be cannulated, followed by real-time percutaneous central vein access.


METHODS
Successful cannulation of a central vein.


RESULTS
All attempts at central vein cannulation were successful. No bleeding complications occurred. One pneumothorax occurred in an obese patient.


CONCLUSIONS
Ultrasound-guided central venous access is a helpful technique to gain venous access in difficult cases. Surgeons who perform central venous access procedures should become acquainted with the techniques involved. The techniques should be incorporated into currently developing ultrasound instruction courses for surgeons.
Department of Surgery, Penrose Hospital, Colorado Springs, Colo., USA. williamfry@centura.org
W R
WR
Fry
G C
GC
Clagett
P T
PT
O'Rourke
D002405:Catheterization, Central Venous / Q000379:methods*; D003199:Computer Systems; D006801:Humans; D011446:Prospective Studies; D018084:Ultrasonography, Interventional