title: Pre-procedure ultrasound increases the success and safety of central venous catheterization†.
abstract: BACKGROUND
  Real-time ultrasound (US) in central venous catheterization is superior to pre-procedure US. However, moving real-time US into routine practice is impeded by its perceived expense and difficulty. Currently, pre-procedure US and landmark (LM) methods are most widely used. We investigated these techniques in internal jugular vein (IJV) catheterization in respect of operator experience, complications, and risk factors.
  
  
  METHODS
  In an observational non-randomized study, we investigated 606 of ∼1300 procedures, that is, 200 patients were treated under pre-procedure US and 406 under LM [pathfinder (PF) n=202, direct cannulation (DC) n=204]. We recorded first needle pass success rate, success rate after the third attempt, and the cannulation time. Procedures were performed by inexperienced (<100) or experienced (>100 catheterizations) operators.
  
  
  RESULTS
  Pre-procedure US was associated with more successful attempts and shorter cannulation times. Under pre-procedure US, 88% of first attempts were successful and 100% of third attempts. The median (range) cannulation time was 39 (10-330) s. Under PF, only 56% of first, and 87% of third, attempts were successful with a median (range) cannulation time of 100 (25-3600) s. Under DC, 61% of first and 89% of third attempts were successful; the median (range) cannulation time was 70 (10-3600) s. Remarkably, inexperienced operators using pre-procedure US (n=38) were significantly faster than experienced operators using PF or DC (n=343) (cannulation time: median 60 s, range 12-330, for inexperienced; 60 s, range 10-3600, for experienced). First puncture success rates were higher (pre-procedure US, inexperienced 84%, PF or DC, experienced 57%).
  
  
  CONCLUSIONS
  Pre-procedure US for IJV catheterization is safe, quick, and superior to LM.
authors.affiliation: Clinic for Anaesthesiology and Intensive Care Medicine, Friedrich Schiller University, 07747 Jena, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Schummer
authors.affiliation: Clinic for Anaesthesiology and Intensive Care Medicine, Friedrich Schiller University, 07747 Jena, Germany Department of Anaesthesiology, Intensive Care and Emergency Medicine, Zentralklinik Bad Berka, Germany.
authors.forename: J A
authors.initials: JA
authors.lastname: Köditz
authors.affiliation: Clinic for Anaesthesiology and Intensive Care Medicine, Friedrich Schiller University, 07747 Jena, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schelenz
authors.affiliation: Clinic for Anaesthesiology and Intensive Care Medicine, Friedrich Schiller University, 07747 Jena, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Reinhart
authors.affiliation: Department of Anaesthesiology and Operative Intensive Care Medicine, University of Witten/Herdecke, Medical Centre Cologne-Merheim, Germany SakkaS@Kliniken-Koeln.de.
authors.forename: S G
authors.initials: SG
authors.lastname: Sakka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D018084:Ultrasonography, Interventional / Q000379:methods; D055815:Young Adult
keywords: cannulation time; central venous catheterization; complications; internal jugular vein; success rate; ultrasound