Cannulation success rates at the first selected central vascular cannulation site can be expected to be in the range of 60 percent in ICU patients similar to the 65 percent success rate for the control group in our series. Other reported series note higher site success rates; however, these patients received elective cannulation preoperatively and were less severely ill than typical ICU patients. Patients in our study, and that of Patel et al, were patients in medical-surgical ICUs, with underlying disorders and management problems which probably make central venous cannulation more difficult.
The utility of ultrasound is impressive. All patients in our study were cannulated at the first selected site with four or fewer needle passes with the assistance of ultrasound guidance, including patients who could not be cannulated with the conventional technique after five unsuccessful cannulation attempts. Ultrasound can be a useful adjunct to central venous cannulation in critically ill patients, especially those who are difficult to cannulate by conventional techniques or those who are at increased risk of cannulation complications.
Other than catheter-related complications which usually occur over a period of days, most immediate complications of internal jugular vein puncture are associated with the needle stick.
Tags: central venous, critically ill patients, ultrasound
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