Usefulness of ultrasound-guided placement of acute hemodialysis catheter

Abstract Failure of central vein cannulation may occur in as high as 10% of cases using anatomical landmark (ALM) as guidance for the direction of needle puncture. In addition, significant time and patient discomfort may be required besides possibility of adverse complications such as hematoma, pneumothorax and arteriovenous fistula formation. Use of ultrasound-guided cannulation of central veins has been studied previously with good results by using dedicated ultrasound probes and needle holder/guides. We tested the results by using dedicated ultrasound probes without the needle holder/guide. Data were analyzed retrospectively over an 8-month period, in attempt to compare, the ultrasound guidance without the needle guide method and the ALM guidance for the placement of central venous catheters in internal jugular and femoral veins. Central vein was located with a 7.5 MHz transducer which is connected to a portable, battery powered, 2-dimentional (2D) echo device. There were total of 48 episodes of central venous cannulation (37 internal jugular and 11 femoral veins). Of these, 25 were done under ultrasound guidance. The number of skin punctures and passes under the skin were lower in the ultrasound-guided group. The vein was entered (passed) during the first attempt in 72% of the ultrasound-guided group, as compared with only 26% of the ALM group. The time needed was under 5 minutes in most ultrasound-guided cases. There were no immediate or late major complications in both groups. We conclude that ultrasound guidance without the need of the dedicated needle guide produces comparable results of fewer venous puncture attempts, increases success rate, and low complications rate. Routine use of ultrasound guided central vein cannulation is encouraged.