title: Real-time ultrasound-aided central vein cannulation failure rate: establishing a benchmark.
abstract: BACKGROUND
  The use of real-time two-dimensional B-mode ultrasound (RTUS)-aided central venous access device (CVAD) insertion has been recommended by health-care agencies, but a realistic failure rate for bedside attempts is unknown.
  
  
  METHODS
  The failure rate of RTUS-aided CVAD insertion is estimated using data from adult inpatients and outpatients referred to a tertiary referral radiology department for a new CVAD insertion during the 2.5-year period ending February 29, 2008. Cannulation failure, complications, and additional fluoroscopic interventions per central vein cannulation attempt and per patient encounter were retrospectively collected and evaluated.
  
  
  RESULTS
  Of the 2456 consecutive patient encounters, the index central vein cannulation failure rate using only RTUS and fluoroscopy was 4.8%; ultimate failure rate was 0.3%. The procedural mortality rate was 0.04%. If the index upper-body central vein cannulation failed, an ipsilateral upper-body attempt through a different central vein failed in 63.6%, whereas a contralateral upper-body attempt failed in 26.7% (p = 0.11) and a common femoral vein attempt failed in 11.5% (p = 0.0039).
  
  
  CONCLUSIONS
  The minimum bedside failure rate of RTUS-aided CVAD insertion is 4.8% for the index central vein cannulated. The ultimate failure rate of 0.3% and the mortality rate of 0.04% are due to RTUS, fluoroscopy, and the additional equipment available in an IR suite. If the upper-body index central vein cannulation fails, cannulation of the common femoral vein is more likely to succeed than additional attempts in other ipsilateral upper-body central veins.
authors.affiliation: Section of Vascular and Interventional Radiology, Department of Radiologic Sciences, Wake Forest University Baptist Medical Center, Medical Center Blvd, Winston Salem, NC 27157, USA. jrequart@wfubmc.edu
authors.forename: Jay A
authors.initials: JA
authors.lastname: Requarth
mesh_terms: D000328:Adult; D019985:Benchmarking; D002405:Catheterization, Central Venous / Q000379:methods*; D006801:Humans; D012189:Retrospective Studies; D017211:Treatment Failure; D014463:Ultrasonography; D014680:Veins / Q000000981:diagnostic imaging*
references.citation: Can Assoc Radiol J. 2001 Dec;52(6):379-84
references.pmid: 11780547
references.citation: Australas Radiol. 2007 Feb;51(1):35-41
references.pmid: 17217487
references.citation: Acta radiol. 1953 May;39(5):368-76
references.pmid: 13057644
references.citation: Circulation. 1993 May;87(5):1557-62
references.pmid: 8491011
references.citation: Bull Am Coll Surg. 2008 Sep;93(9):35-6
references.pmid: 19469356
references.citation: AJR Am J Roentgenol. 1998 Nov;171(5):1259-63
references.pmid: 9798857