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Single-Operator Ultrasound-Guided Central Venous Catheter Insertion Verifies Proper Tip Placement*

Galante, Ori MD1; Slutsky, Tzachi MD2; Fuchs, Lior MD1; Smoliakov, Alexander MD3; Mizrakli, Yuval BSc4; Novack, Victor MD PhD4; Brotfein, Evgeni MD5; Klein, Moti MD5; Frenkel, Amit MD5; Koifman, Leonid MD5; Almog, Yaniv MD1

doi: 10.1097/CCM.0000000000002500
Online Clinical Investigations

Objectives: To evaluate whether a single-operator ultrasound-guided, right-sided, central venous catheter insertion verifies proper placement and shortens time to catheter utilization.

Design: Prospective observational study with historical controls.

Setting: Adult ICUs.

Patients: Sixty-four consecutive patients undergoing ultrasound-assisted right-sided central venous catheterization compared with 92 serial historic controls who had unassisted central catheter insertion at the same sites.

Interventions: Subcostal transthoracic echocardiography during catheter insertion.

Measurements and Main Results: The primary outcome was the correct placement of the catheter tip determined by postprocedural chest radiography. The subclavian site was used in 41 patients (64%) (inserted without ultrasound guidance) in the ultrasound-assisted group and 62 (67%) in the control group, whereas the jugular vein was used in the remaining patients. The tip was accurately positioned in 59 of 68 patients (86.7%) in the ultrasound-assisted group compared with 51 of 94 (54.8%) in the control group (p < 0.001). The median time from end of the procedure to catheter utilization after chest radiography approval was 2.4 hours.

Conclusions: A single-operator ultrasound-guided central venous catheter insertion is effective in verifying proper tip placement and shortens time to catheter utilization.

1Medical Intensive Care Unit, Soroka University Medical Center; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.

2Department of Medicine, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.

3Institute of Diagnostic Radiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.

4Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.

5Surgical Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.

*See also p. 1793.

Drs. Galante and Slutsky equally contributed.

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: yaniva@clalit.org.il

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