Evaluation of ultrasound for central venous access in ICU by an in experienced trainee.

BACKGROUND AND AIMS: Central venous catheter placement is an important procedure for ICU (Intensive Care Unit) patients. We studied the usefulness of ultrasonography for placement of central venous catheter by in-experienced anesthetists.

MATERIALS AND METHODS: A prospective observational study of 32 patients requiring central venous access (CVA) in surgical ICU (SICU). Data collected were patient's demographics, indication, type of catheter, success rate, attempts, complication rate and access time were recorded and compared with other studies.

RESULT: The overall success rate was 89.5% in the IJV (Internal Jugular Vein) and 92.3% for SCV (Subclavian Vein) group. The success rates for insertion at first, second, and third attempt were 52.6%, 31.6%, and 5.2% for IJV and 46.2% and 53.8% for SCV. Average number of attempts made for IJV cannulation was 1.74 +/- 1.04 and 1.54 +/- 0.51 for SCV. The total time taken for IJV access was 858.78 +/- 381.9 sec, whereas in the SCV group, it was 984 +/- 328.98 seconds. In our study, overall rate of complication was 21.05% (4/19 patients) for IJV and 23.07% (3/13 patients) for SCV insertion. Incidence of various complications like arterial puncture, misplacement of CVC, hematoma, pneumothorax, and hemothorax were also noted.

CONCLUSION: This study concludes that real time ultrasound guidance during IJV and SCV cannulation can achieve higher success rate, fewer complications, number of attempts, and failure rate among inexperienced anesthetists.