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Central Venous Catheter Insertion: It is Finally Time to Start Looking

Section Editor(s): Saidman, LawrenceUrdaneta, Felipe MD; Gravenstein, Nikolaus MD

doi: 10.1213/01.ane.0000270266.32684.12
Letters to the Editor: Letters & Announcements

Departments of Anesthesiology and Neurosurgery; University of Florida College of Medicine; Malcolm Randall Veterans Administration Medical Center; Gainesville, FL;

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To the Editor:

After reading the recent article by Bailey et al. (1), we were very disappointed to realize that ultrasound, the safest, most cost-effective, and successful method for central venous catheterization placement compared with the traditional percutaneous landmark-based approach for cannulation of the internal jugular vein has not been implemented by the majority of cardiac anesthesiologists.

The reported low use of ultrasound is surprising when considering that in previous study 94% of SCA members reported that they worked at places where intraoperative transesophageal echocardiography was used, and the majority stated that transesophageal echocardiography was performed by an anesthesiologist (2). Because both studies were based on voluntary information from members responding to the survey, it is possible that the survey was limited; however it may also represent failure of a large proportion of SCA members to use ultrasound for catheter insertion despite substantial and consistent evidence supporting its use (3,4).

Use of ultrasound guidance during central venous catheterization placement is among the top 10 evidence-based tools that health care providers can use to improve patient safety (5). Can we afford to continue to ignore the benefits associated with the use of ultrasound for central venous catheterization placement or should we accept our responsibility to apply safety innovations and quality initiatives in the tradition of our specialty?

Felipe Urdaneta, MD

Nikolaus Gravenstein, MD

Departments of Anesthesiology and Neurosurgery

University of Florida College of Medicine

Malcolm Randall Veterans Administration Medical Center

Gainesville, FL

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1. Bailey PL, Glance LG, Eaton MP, Parshall B, McIntosh S. A survey of the use of ultrasound during central venous catheterization. Anesth Analg 2007;104:491–7
2. Morewood GH, Gallagher ME, Gaughan JP, Conlay LA. Current practice patterns for adult perioperative transesophageal echocardiography in the United States. Anesthesiology 2001;95:1507–12
3. Randolph AG, Cook DJ, Gonzales CA, Pribble CG. Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med 1996;24:2053–8
4. Hind D, Calvert N, McWilliams R, Davidson A, Paisley S, Beverley C, Thomas S. Ultrasonic locating devices for central venous cannulation: meta-analysis. BMJ 2003; 327:361
5. Rothschild JM. Ultrasound guidance of central vein catheterization. In: On making health care safer: a critical analysis of patient safety practices. Rockville, MD: AHRQ Publications, 2001; Chapter 21: 245–55
© 2007 International Anesthesia Research Society