Landmark Central Venous Catheterization is Effective but Ultrasound Helps Even in Experienced Hands

Abstract

Introduction: A recent report published by the American Society of Anesthesiologists (ASA) task force on central venous access suggests the use of real time ultrasound for placing central venous lines. As in our center there is no ultrasound device specific for this purpose, a decision to test the hypothesis whether anatomic landmark for central venous catheterization is effective in experienced hands was made.
Methods: A retrospective review of a prospectively collected database was performed for the period January 2002 to June 2013. Five hundred fifty patients underwent long-term central venous catheter placement. All procedures were performed by experienced (>50 placements) surgeons utilizing standard techniques.
Results: Males slightly predominated, corresponding to 51.3% (n=282) of the total population. The most frequent cannulated vein was the subclavian vein (n=451/82%). The Right Subclavian Vein (RSV) was the first choice for catheterization (n=410/74.5%). 83.5% (n=459) of the punctures were successful on the first attempt. Complications included arterial puncture (n=36/6.5%), hematoma (n=16/2.9%) and pneumothorax (n=4/0.7%). Ultrasound was used in selective high-risk cases (7.3%).
Conclusion: The data suggests that with proper skill and experience, landmark anatomic position is effective for central venous catheterization, however ultrasound is helpful in specific difficult cases.