title: Doppler-guided cannulation of internal jugular vein, subclavian vein and innominate (brachiocephalic) vein--a case-control comparison in patients with reduced and normal intracranial compliance.
abstract: OBJECTIVE
  A case-control comparison of Doppler guidance on the success rate of central venous cannulation in patients with normal or reduced intracranial compliance.
  
  
  METHODS
  A single operator performed central venous access procedures with continuous wave Doppler guidance. It was used on patients on a ventilator. The position of patients with reduced intracranial compliance (RIC) was not changed for the procedure. Patients with normal intracranial compliance (NIC) were put in the Trendelenburg position.
  
  
  METHODS
  We prospectively evaluated 249 Doppler-guided central venous access procedures performed over a 12-month period at our 10-bed neuro-intensive care unit at a university hospital.
  
  
  METHODS
  The group with RIC included 26 males and 35 females (n=61) aged 16-79 years. In this group 155 Doppler-guided cannulation procedures (62%) were performed. The group with NIC (n=52) comprised 29 males and 23 females aged 34-76 years; 94 Doppler-guided cannulation procedures (38%) were carried out.
  
  
  RESULTS
  The veins cannulated in RIC and NIC, respectively, were: right innominate vein: 24/18, left innominate vein 26/12, right subclavian vein 12/7, left subclavian vein 25/14, and right internal jugular vein 33/18 and left internal jugular vein 35/24. The absence of one left internal jugular vein was identified in the NIC group. The success rate of first needle pass in patients with RIC was 92% and in patients with NIC 89%.
  
  
  CONCLUSIONS
  This study showed that Doppler guidance allows the cannulation of central veins in patients with RIC placed in head-up position. Cannulation can be ensured and first-pass needle placement maximised.
authors.affiliation: Clinic for Anaesthesiology and Intensive Care Medicine, Friedrich-Schiller University of Jena, Bachstrasse 18, 07745 Jena, Germany. cwsm.schummer@gmx.de
authors.forename: Wolfram
authors.initials: W
authors.lastname: Schummer
authors.forename: Claudia
authors.initials: C
authors.lastname: Schummer
authors.forename: Wolf-Dirk
authors.initials: WD
authors.lastname: Niesen
authors.forename: Hendrik
authors.initials: H
authors.lastname: Gerstenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000379:methods*; D005260:Female; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011187:Posture; D011446:Prospective Studies; D013350:Subclavian Vein / Q000000981:diagnostic imaging*; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods*