Ultrasound Guidance Improves the Success Rate of Internal Jugular Vein Cannulation: Results (2)

Using conventional landmarks, seven of 17 (41 percent; 95 percent confidence interval: 18 to 67 percent) patients were cannulated w ith the first needle pass. Three often (30 percent; 95 percent confidence interval: 7 to 65 percent) patients were cannulated with the second needle pass, none of seven (0 percent; 95 percent confidence interval: 0 to 35 percent) were cannulated with the third needle pass, one of seven (14 percent; 95 percent confidence interval: 0.3 to 58 percent) was successfully cannulated with the fourth pass, and none of six (0 percent; 95 percent confidence interval: 0 to 39 percent) patients were cannulated w ith a fifth needle pass (Fig 4).
Using ultrasound guidance, cannulation success w ith each pass was seven of 12 (58 percent; 95 percent confidence interval: 25 to 85 percent on the first needle pass, two of five (40 percent; 95 percent confidence interval: 5 to 85 percent) w ith the second, two of three (67 percent; 95 percent confidence interval: 10 to 99 percent) with the third, and one of one (100 percent; 95 percent confidence interval: 0 to 100 percent) w ith the fourth needle pass (Fig 4). Twodimensional ultrasound also reduced the mean number of passes required to cannulate the vein from at least 3.12 to 1.75 (p<0.05, Mantel-Haenszel test). The mean of 3.12 understates the result because patients w ho could not be cannulated w ere not counted in the mean of this statistical comparison.

Figure 4. Cannulation success r.v consecutive needle thrusts. Using conventional (CONVENT) technique (broken line) the chance for successful cannulation tended to decrease with each attempted site. With two-dimensional ultrasound (2DUS) (solid line), a targeting effect occurred, with a tendency toward higher success rates at all sites; 95 percent confidence limits for each thrust art* as described in the text. The solid and broken lines represent first-order polynomial lines of best fit for two-dimensional and conventional ultrasound, respectively.

Category: Ultrasound

Tags: central venous, critically ill patients, ultrasound