Abstract
Background
Ultrasound-guidance for internal jugular central venous cannulation (CVC) has become
the recommended best practice and has been shown to improve placement success and
reduce complications. There is a dearth of studies that evaluate emergency point-of-care
ultrasound guidance of femoral CVC.
Objective
Our aim was to determine if point-of-care ultrasound guidance for femoral CVC decreases
adverse events and increases the likelihood of successful placement when compared
with the landmark technique.
Methods
We conducted an Institutional Review Board–approved, prospective, observational study
of consecutive patients who required CVC. Physicians who performed CVC completed a
standardized, web-based data sheet for a national CVC registry. We evaluated single-institution
data regarding CVC site, ultrasound usage, CVC indication, and mechanical complications
(e.g., pneumothorax, arterial puncture, failed access, catheter misdirection, and
hematoma). The study period was between January 2006 and June 2010. Analysis using
Pearson's χ2 and Agresti-Coull binomial confidence intervals was performed; significance was defined
as p < 0.05.
Results
We evaluated data for 143 patients who had femoral CVC in our institution. Sixty CVCs
(42%) were performed under ultrasound guidance, 83 (58%) via landmark technique (p = 0.0159); 3.3% of femoral central venous lines placed by ultrasound guidance had
recorded adverse events compared with 9.6% for the landmark technique (p = 0.145). There was no statistically significant difference in complications between
ultrasound-guidance and landmark techniques. Our data showed a trend toward decreased
rates of arterial puncture and reduced cannulation attempts resulting in improved
placement success.
Conclusions
Our experience shows that ultrasound guidance for femoral CVC might decrease complications
and improve placement success, although we cannot recommend this approach without
additional data. We recommend a larger study to further evaluate this technique.
Keywords
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Article info
Publication history
Published online: January 24, 2014
Accepted:
August 14,
2013
Received in revised form:
March 22,
2013
Received:
April 30,
2012
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
