Real-time ultrasound guided placement of temporary internal jugular vein catheters: assessment of technical success and complication rates in nephrology practice.
OBJECTIVE
Internal jugular vein (IJV) catheterization is often required to gain access for haemodialysis. Use of ultrasound guidance has reduced the complication rates of this procedure. We hypothesized that nephrologists may perform IJV cannulation with a high technical success and low immediate complication rates under real-time ultrasound guidance.


METHODS
We prospectively analyzed 323 patients (186 male, 137 female) who underwent IJV cannulation with real-time ultrasound guidance. The number of needle punctures, technical success, the time between injection of local anaesthetic and entry into the IJV, and immediate complications were recorded. Patients with a history of multiple catheter insertions, previous difficulties during catheterization, poor compliance, obesity, impaired consciousness, skeletal deformity, disorder of haemostasis were regarded as high-risk group.


RESULTS
Cannulation of IJV was achieved in all patients. Of the 323 catheters, 125 (38.7%) were placed in high-risk patients. Average number of puncture was 1.26 (range, 1-4). IJV was entered on the first attempt in 261 (80.8%) patients. Only ten complications (10/323, 3.2%) developed; five (2.5%) in the normal-risk group, and five (4.0%) in the high-risk group. Cannulation of IJV took a longer time in the high-risk group than in the normal-risk group. The number of needle punctures, percent of successful cannulation on the first attempt, and the frequency of complications were similar between the high- and normal-risk groups.


CONCLUSIONS
Cannulation of IJV under real-time ultrasound guidance is very safe with high technical success rates. Nephrologists can use this technique with ease and with minimal complications in normal- and high-risk patients.
Department of Nephrology, Ankara Numune Research and Education Hospital, Ankara, Turkey. drakeomd@yahoo.com
Hadim
H
Akoglu
Serhan
S
Piskinpasa
Ezgi C
EC
Yenigun
Ramazan
R
Ozturk
Fatih
F
Dede
Ali R
AR
Odabas
D000368:Aged; D000772:Anesthesia, Local; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D062905:Central Venous Catheters; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009398:Nephrology; D061214:Patient Safety; D011446:Prospective Studies; D011677:Punctures; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014421:Turkey; D018084:Ultrasonography, Interventional