title: Ultrasound-guided internal jugular vein catheterization: a randomized controlled trial.
abstract: BACKGROUND
  Even though advantages of ultrasound line placement seem obvious, many countries do not have easy access to such technology. This study aims to compare the degree of difficulty in central venous line placement with or without ultrasound and the incidence of complications, and to establish the effect of the operator's degree of training.
  
  
  METHODS
  The study included 257 patients that required central venous catheterization during the study period. Patients were divided into groups according to the operator's experience: expert group (over 70 central accesses performed before the study) (n=152) and in-training or non-expert group. Procedures were randomized to "without ultrasound" (n=80 expert and 54 non-expert) and "with ultrasound" (n=72 expert and 51 non-expert).
  
  
  RESULTS
  Catheter placements were more successful in the "expert" and in the "with ultrasound" than in the "non-expert" (88% vs 79%; p=0.04) or in the "without ultrasound" groups (91% vs 78%; p=0.005). Incidence of complications was 11.7%, with no significant difference among "with ultrasound" (8.1%) and "without ultrasound" (14.9%) groups. However, the "non-expert" group had fewer complications with the use of ultrasound (7.8% vs 24%).
  
  
  CONCLUSIONS
  Ultrasound reduces the incidence of complications when placement is performed by inexperienced operators. Centers with residents should emphasize the necessity of ultrasound for central line catheterization. Training in ultrasound might be of paramount importance in the effectiveness of the technique.
authors.affiliation: Departamento de Anestesia, Universidad de la República, Montevideo, Uruguay. ; Unidad Bi-Institucional de Trasplante Hepático y UDA-Centro Nacional Hepato-Bilio-Pancreático, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay.
authors.forename: K
authors.initials: K
authors.lastname: Rando
authors.affiliation: Unidad Bi-Institucional de Trasplante Hepático y UDA-Centro Nacional Hepato-Bilio-Pancreático, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay. ; Departamento de Medicina Intensiva, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay.
authors.forename: J
authors.initials: J
authors.lastname: Castelli
authors.affiliation: Departamento de Medicina Intensiva, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay.
authors.forename: J P
authors.initials: JP
authors.lastname: Pratt
authors.affiliation: Universidad de la República, Montevideo, Uruguay. ; Instituto de Estadística (IESTA), Universidad de la República, Montevideo, Uruguay.
authors.forename: M
authors.initials: M
authors.lastname: Scavino
authors.affiliation: Instituto de Estadística (IESTA), Universidad de la República, Montevideo, Uruguay.
authors.forename: G
authors.initials: G
authors.lastname: Rey
authors.affiliation: Instituto de Estadística (IESTA), Universidad de la República, Montevideo, Uruguay.
authors.forename: M E
authors.initials: ME
authors.lastname: Rocca
authors.affiliation: Departamento de Anestesia, Universidad de la República, Montevideo, Uruguay.
authors.forename: G
authors.initials: G
authors.lastname: Zunini
keywords: anesthesia; central venous line; intensive care unit; ultrasound