Ultrasound Enables Safer, Faster Venous Catheterization

In an article published November 17, 2006, in the journal Critical Care, researchers reported the results of a prospective randomized controlled trial comparing the use of ultrasound to guide catheterization to the traditional method utilizing physical landmarks. The researchers reported a success rate of 100% for ultrasound-guided catheterization of the internal jugular vein. They demonstrated that the method is less likely to result in bloodstream infections or complications, such as puncture of an artery, than the traditional catheterization procedure.

Dr. Dimitrios Karakitsos, from the intensive care unit of the General State Hospital of Athens (Greece), and colleagues from other institutions in Greece, The Netherlands, and the United States, compared the outcome of internal jugular vein catheterization in 450 patients for whom the procedure was guided by ultrasound and in 450 patients for whom physical landmarks were used for guidance. During the ultrasound-guided catheterization, the physician is aided by ultrasound-generated, real-time, two-dimensional images of the jugular vein. The patients were matched between the two groups for age, gender, body mass index (BMI), and risk factors for complications following catheterization.

The study's results show an overall success rate of 100% for ultrasound-guided catheterization and a 94% success rate for the conventional procedure. Very few cases of carotid puncture or hematoma and no instances of hemothorax or pneumothorax were reported following ultrasound-guided catheterization. In contrast, hematoma occurred in 8.4% of patients who had a standard catheterization. Hemothorax occurred in 1.7% and carotid-artery puncture occurred in 10.6% of the patients undergoing standard catheterization.

The researchers' findings also demonstrate that 16% of patients who received the standard procedure had a central venous catheter-associated bloodstream infection, compared to 10.4% of patients who had the ultrasound-guided procedure. The time taken to insert the catheter and the number of attempts were also greatly reduced for patients who received the ultrasound-guided procedure.

The investigators concluded, "Ultrasound imaging is a readily available technology and may be employed by inexperienced operators to facilitate the placement of a central venous catheter as well as by experienced operators in order to improve the safety of the procedure.”

In an accompanying editorial in the same issue, Dr. Andrew Bodenham, from Leeds General Infirmary (UK), added, "In the past, it was possible to defend clinicians not using ultrasound on the basis that it was not yet routine practice but I think this position will become increasingly untenable in the future.”