Is routine ultrasound guidance for central line placement beneficial? A prospective analysis

Matthew J. Martin, Farah Husain, Michael Piesman, Philip S. Mullenix, Scott R. Steele, Charles A. Andersen, George N. Giacoppe

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objective: Portable ultrasound devices have become more readily available in the intensive care unit setting, but their utility outside of controlled trials remains unproven. We sought to determine how the availability of ultrasound guidance affected the types and number of complications during central line placement. Design: Review of a prospectively maintained database in a 20-bed combined intensive care unit. Procedure notes from all attempts at internal jugular vein access from 1996 to 2001 were recorded, and selected patient records were reviewed. Ultrasound guidance was available beginning in March 1998. Results: From 1996 to 2001, there were 484 documented attempts at internal jugular central line placement. Most procedures (83%) were performed by first- or second-year residents. During this period, there were 47 complications for an overall complication rate of 10%. These included 1 pneumothorax (2%), 6 carotid punctures (13%), 2 hematomas (4%), and 34 unsuccessful attempts (72%). There was no significant difference in age, sex, body-mass index, or intubation status between those with and without complications or between the ultrasound and anatomic landmark groups. Ultrasound was used in 179 (37%) attempts. The overall complication rate with ultrasound was 11% versus 9% using anatomic landmarks (p = NS). The complication rate prior to the availability of ultrasound was 15 of 114 attempts (13%) versus 32 of 370 attempts (9%) after the introduction of ultrasound in our intensive care unit (p = NS). Analysis of the 370 procedures performed since ultrasound became available demonstrated a complication rate of 11% with ultrasound guidance versus 6% without (p = 0.09). There was no significant difference in complication rates by resident year group or department (surgery vs. other). However, procedures performed after-hours (1800 to 0800) were associated with a 15% complication rate versus 6% for procedures performed during the workday (p <0.05). Conclusion: The availability and use of ultrasound guidance for central line placement by junior residents has not resulted in an improvement in procedure-related complications. The complication profile was not affected by ultrasound use, patient factors, or resident year in training. There was a higher complication rate associated with procedures performed at night that may be caused by resident fatigue or unavailability of senior supervision.

Original languageEnglish (US)
Pages (from-to)71-74
Number of pages4
JournalCurrent Surgery
Volume61
Issue number1
DOIs
StatePublished - Jan 2004
Externally publishedYes

Fingerprint

resident
Anatomic Landmarks
Intensive Care Units
Jugular Veins
Pneumothorax
Punctures
fatigue
Intubation
Hematoma
surgery
Fatigue
supervision
Body Mass Index
Neck
Group
Databases
Equipment and Supplies

Keywords

  • Catheterization
  • Central venous
  • Interventional
  • Jugular veins
  • Site-Rite
  • Ultrasonography

ASJC Scopus subject areas

  • Surgery

Cite this

Martin, M. J., Husain, F., Piesman, M., Mullenix, P. S., Steele, S. R., Andersen, C. A., & Giacoppe, G. N. (2004). Is routine ultrasound guidance for central line placement beneficial? A prospective analysis. Current Surgery, 61(1), 71-74. https://doi.org/10.1016/j.cursur.2003.07.010

Is routine ultrasound guidance for central line placement beneficial? A prospective analysis. / Martin, Matthew J.; Husain, Farah; Piesman, Michael; Mullenix, Philip S.; Steele, Scott R.; Andersen, Charles A.; Giacoppe, George N.

In: Current Surgery, Vol. 61, No. 1, 01.2004, p. 71-74.

Research output: Contribution to journalArticle

Martin, MJ, Husain, F, Piesman, M, Mullenix, PS, Steele, SR, Andersen, CA & Giacoppe, GN 2004, 'Is routine ultrasound guidance for central line placement beneficial? A prospective analysis', Current Surgery, vol. 61, no. 1, pp. 71-74. https://doi.org/10.1016/j.cursur.2003.07.010
Martin, Matthew J. ; Husain, Farah ; Piesman, Michael ; Mullenix, Philip S. ; Steele, Scott R. ; Andersen, Charles A. ; Giacoppe, George N. / Is routine ultrasound guidance for central line placement beneficial? A prospective analysis. In: Current Surgery. 2004 ; Vol. 61, No. 1. pp. 71-74.
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abstract = "Objective: Portable ultrasound devices have become more readily available in the intensive care unit setting, but their utility outside of controlled trials remains unproven. We sought to determine how the availability of ultrasound guidance affected the types and number of complications during central line placement. Design: Review of a prospectively maintained database in a 20-bed combined intensive care unit. Procedure notes from all attempts at internal jugular vein access from 1996 to 2001 were recorded, and selected patient records were reviewed. Ultrasound guidance was available beginning in March 1998. Results: From 1996 to 2001, there were 484 documented attempts at internal jugular central line placement. Most procedures (83{\%}) were performed by first- or second-year residents. During this period, there were 47 complications for an overall complication rate of 10{\%}. These included 1 pneumothorax (2{\%}), 6 carotid punctures (13{\%}), 2 hematomas (4{\%}), and 34 unsuccessful attempts (72{\%}). There was no significant difference in age, sex, body-mass index, or intubation status between those with and without complications or between the ultrasound and anatomic landmark groups. Ultrasound was used in 179 (37{\%}) attempts. The overall complication rate with ultrasound was 11{\%} versus 9{\%} using anatomic landmarks (p = NS). The complication rate prior to the availability of ultrasound was 15 of 114 attempts (13{\%}) versus 32 of 370 attempts (9{\%}) after the introduction of ultrasound in our intensive care unit (p = NS). Analysis of the 370 procedures performed since ultrasound became available demonstrated a complication rate of 11{\%} with ultrasound guidance versus 6{\%} without (p = 0.09). There was no significant difference in complication rates by resident year group or department (surgery vs. other). However, procedures performed after-hours (1800 to 0800) were associated with a 15{\%} complication rate versus 6{\%} for procedures performed during the workday (p <0.05). Conclusion: The availability and use of ultrasound guidance for central line placement by junior residents has not resulted in an improvement in procedure-related complications. The complication profile was not affected by ultrasound use, patient factors, or resident year in training. There was a higher complication rate associated with procedures performed at night that may be caused by resident fatigue or unavailability of senior supervision.",
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N2 - Objective: Portable ultrasound devices have become more readily available in the intensive care unit setting, but their utility outside of controlled trials remains unproven. We sought to determine how the availability of ultrasound guidance affected the types and number of complications during central line placement. Design: Review of a prospectively maintained database in a 20-bed combined intensive care unit. Procedure notes from all attempts at internal jugular vein access from 1996 to 2001 were recorded, and selected patient records were reviewed. Ultrasound guidance was available beginning in March 1998. Results: From 1996 to 2001, there were 484 documented attempts at internal jugular central line placement. Most procedures (83%) were performed by first- or second-year residents. During this period, there were 47 complications for an overall complication rate of 10%. These included 1 pneumothorax (2%), 6 carotid punctures (13%), 2 hematomas (4%), and 34 unsuccessful attempts (72%). There was no significant difference in age, sex, body-mass index, or intubation status between those with and without complications or between the ultrasound and anatomic landmark groups. Ultrasound was used in 179 (37%) attempts. The overall complication rate with ultrasound was 11% versus 9% using anatomic landmarks (p = NS). The complication rate prior to the availability of ultrasound was 15 of 114 attempts (13%) versus 32 of 370 attempts (9%) after the introduction of ultrasound in our intensive care unit (p = NS). Analysis of the 370 procedures performed since ultrasound became available demonstrated a complication rate of 11% with ultrasound guidance versus 6% without (p = 0.09). There was no significant difference in complication rates by resident year group or department (surgery vs. other). However, procedures performed after-hours (1800 to 0800) were associated with a 15% complication rate versus 6% for procedures performed during the workday (p <0.05). Conclusion: The availability and use of ultrasound guidance for central line placement by junior residents has not resulted in an improvement in procedure-related complications. The complication profile was not affected by ultrasound use, patient factors, or resident year in training. There was a higher complication rate associated with procedures performed at night that may be caused by resident fatigue or unavailability of senior supervision.

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