title: Three-step method for ultrasound-guided central vein catheterization.
abstract: BACKGROUND
  The long-axis view and in-plane needle approach (LAX-IP) for ultrasound-guided central vein catheterization is considered ideal because of the quality of real-time imaging. We describe a novel technique, using a step-by-step procedure, to overcome the pitfalls associated with the LAX-IP. This study was undertaken to demonstrate the clinical utility of this approach.
  
  
  METHODS
  All operators underwent training before participation in this study. One hundred patients were enrolled in this study and underwent central venous catheterization using this method. Using a portable ultrasound and vein catheterization kit, patients were appropriately positioned and a straight portion of the vein identified (Step 1). A needle guide was used (Step 2) and the vein imaged in real time in two directions (Step 3), to identify the true long axis and prevent damage to surrounding tissues.
  
  
  RESULTS
  The overall success rate for catheterization was 100% with a median of one puncture for each patient. All catheterizations were performed within three punctures. Problems with the first puncture included difficult insertion of the guide-wire due to coiling, difficult anterior wall puncture, less experience with the procedure, and other reasons. There were no complications associated with the procedure.
  
  
  CONCLUSIONS
  This three-step method is not dependent on an operator's ability to proceed based on spatial awareness, but rather depends on logic. This method can prevent difficulties associated with a two-dimensional ultrasound view, and may be a safer technique compared with others. Further clinical trials are needed to establish the safety of this technique.
authors.affiliation: Department of Anesthesia, Seikei-kai Chiba Medical Center, 1-11-12, Minami-cho, Chuo-ku, Chiba-shi 260-0842, Japan. ii36469@wa2.so-net.ne.jp
authors.forename: J
authors.initials: J
authors.lastname: Tokumine
authors.forename: A T
authors.initials: AT
authors.lastname: Lefor
authors.forename: A
authors.initials: A
authors.lastname: Yonei
authors.forename: A
authors.initials: A
authors.lastname: Kagaya
authors.forename: K
authors.initials: K
authors.lastname: Iwasaki
authors.forename: Y
authors.initials: Y
authors.lastname: Fukuda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000776:Anesthesiology / Q000193:education; D002405:Catheterization, Central Venous / Q000379:methods*; D002983:Clinical Competence; D005260:Female; D018475:Head-Down Tilt; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008297:Male; D008348:Manikins; D008875:Middle Aged; D009339:Needles; D011677:Punctures / Q000379:methods; D018084:Ultrasonography, Interventional / Q000295:instrumentation* / Q000379:methods*; D014680:Veins / Q000000981:diagnostic imaging*