Ultrasonography: a novel approach to central venous cannulation.
BACKGROUND
Portable ultrasound machines are highly valuable in ICUs, where a patient's condition might not permit shifting the patient to the USG department for imaging. Traditionally central lines are put blindly using anatomical landmarks, which often result in complications such as difficulty in access, misplaced lines, pneumothorax, bleeding from inadvertent arterial punctures, etc. Ultrasonography provides "real time" imaging, i.e., the needle can be visualized entering the vein.


OBJECTIVE
We performed a study to compare USG guided central venous cannulation (CVC) and conventional anatomical landmark approach to CVC, in terms of ease of cannulation, time consumed, and associated complications.


METHODS
The study was performed in a 16-bed open ICU. Eighty patients were randomly divided in two groups.


METHODS
The right internal jugular vein (IJV) was cannulated in all. In Group I, a portable ultrasound machine was used during cannulation. The vessels were visualized in the transverse section with the internal carotid artery (ICA) identified as a circular pulsatile structure, while the IJV as a lateral, oval nonpulsatile structure). The needle was inserted perpendicular to the skin under visualization on the US screen. Central venous line was then inserted by the Seldinger technique. In Group II, CVC was performed by the conventional landmark approach. The parameters studied included time for insertion, attempts required, and complications encountered.


METHODS
The database of all parameters was analyzed using SPSS software version 10.5.


RESULTS
The mean time to successful insertion was 145 and 176.4 sec in groups I and II, respectively (p = 0.00). An average of 1.2 attempts per cannulation was required for group I, while 1.53 for group II (p = 0.03): 10% witnessed arterial puncture and 2.5% pneumothorax in group I and none in group II.


CONCLUSIONS
USG-guided CVC is thus easier, quicker, and safer than landmark approach.
Agarwal
Ankit
A
Department of Anaesthesiology and Intensive Care, BHU, Varanasi, India. drankit80@gmail.com
Singh
Dinesh K
DK
Singh
Anil P
AP