Ultrasound-guided central venous cannulation is superior to quick-look ultrasound and landmark methods among inexperienced operators: a prospective randomized study

• Published in: Intensive care medicine 2013-11, Vol.39 (11), p.1938-1944
• Main Authors: Airapetian, Norair, Maizel, Julien, Langelle, François, Modeliar, Santhi Samy, Karakitsos, Dimitrios, Dupont, Herve, Slama, Michel
• Format: Article
• Language: English
• Subjects: Age; Aged; Analysis; Anesthesiology; Catheterization, Central Venous - methods; Catheters; Clinical Competence; Consent; Critical Care Medicine; Emergency Medicine; Female; Femoral Vein; Hospital patients; Humans; Intensive; Intensive care; Intensive Care Units; Internship and Residency; Intubation; Jugular Veins; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Methods; Middle Aged; Original Article; Pain Medicine; Patient safety; Pediatrics; Pneumology/Respiratory System; Prospective Studies; Skin; Ultrasonic imaging; Ultrasonography, Interventional; Veins & arteries
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-013-3072-z

Objective Quick-look ultrasound with a skin mark (UM) has been frequently used for central vein cannulation. The aim of this study is to compare this method with landmark (LM) and ultrasound-guided (UG) cannulation of jugular and femoral veins by inexperienced operators. Design Prospective randomized single-center study. Setting A medical intensive care unit (ICU) of a university medical center. Patients Patients requiring jugular or femoral central cannula placement. Intervention Each inexperienced resident randomly inserted a central venous line using the UM, LM or UG technique. Measurements and findings The primary outcome was the success rate, and secondary outcomes were the placement time, number of attempts, mechanical complication rate, and catheter colonization rate. A total of 118 patients were randomly assigned to the three groups. The mean age of patients included in the study was 65 ± 15 years, and the mean Simplified Acute Physiology Score 2 (SAPS2) was 57 ± 20. The success rate was higher in the UG group than in the LM and UM groups (100, 74, and 73 %, respectively; p  = 0.01). The total number of mechanical complications was higher in the LM and UM groups than in the UG group (24 and 36 versus 0 %, respectively; p  = 0.01). The number of attempts and the access time were higher in the LM group than in the UG group, but not compared with the UM group. No difference in terms of catheter colonization was observed between the three groups. Conclusions Ultrasound-guided cannulation of the internal jugular or femoral vein by inexperienced residents appears to be more reliable than the LM or UM methods and was associated with a lower mechanical complication rate among ICU patients.