title: Implantation of 3951 long-term central venous catheters: performances, risk analysis, and patient comfort after ultrasound-guidance introduction.
abstract: BACKGROUND
  Despite evidence demonstrating improved safety with ultrasound-guided placement of central venous catheters (CVC) in comparison with the use of anatomical landmarks, ultrasound guidance is still not routinely used by all physicians when obtaining central venous access.
  
  
  METHODS
  We report data pertaining to the placement of long-term CVCs in a 7-year period before and after ultrasound guidance was introduced. We included 3951 procedures (total of 1,642,402 catheter days) in our study: 1584 using the anatomical landmark method (landmark group, January 2000 to May 2003), and 2367 with ultrasound guidance (ultrasound group, June 2003 to May 2007). All procedures were performed by the same team of intensivists. Comparison criteria included procedural data, complications, patient's comfort, and perceptions. Variables were analyzed with Student's t test and χ(2) test. Multivariate analysis was performed according to the Cox proportional hazards regression model.
  
  
  RESULTS
  Using ultrasound guidance, we noted a significant reduction in procedure time in both port (mean difference 4.9 ± 0.4 minutes, confidence interval [CI] 4.1 to 5.7) and tunneled catheter (mean difference 2.4 ± 0.8 minutes, CI 0.9 to 3.8) placement. The landmark method was associated with an increased risk of overall perioperative complications (4.5, CI 3.6 to 5.6). Among disease entities, acute leukemia patients had a significantly higher risk of CVC-related infections (2.6, CI 2.1 to 3.8). On the basis of questionnaires submitted to patients from both groups, ultrasound guidance was associated with improved patient comfort and satisfaction.
  
  
  CONCLUSIONS
  Ultrasound guidance reduces complications and improves patient comfort. Further studies are needed to define whether acute leukemia patients should be considered a separate category with regard to the higher incidence of infections.
authors.affiliation: Anesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Florence, Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Peris
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zagli
authors.forename: Manuela
authors.initials: M
authors.lastname: Bonizzoli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cianchi
authors.forename: Marco
authors.initials: M
authors.lastname: Ciapetti
authors.forename: Rosario
authors.initials: R
authors.lastname: Spina
authors.forename: Valentina
authors.initials: V
authors.lastname: Anichini
authors.forename: Francesco
authors.initials: F
authors.lastname: Lapi
authors.forename: Stefano
authors.initials: S
authors.lastname: Batacchi
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries / Q000293:injuries; D055499:Catheter-Related Infections / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects; D016009:Chi-Square Distribution; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011030:Pneumothorax / Q000209:etiology; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D020246:Venous Thrombosis / Q000209:etiology; D014950:Wounds, Penetrating / Q000209:etiology