Ultrasound guidance for central venous catheter placement: results from the Central Line Emergency Access Registry Database1
Abstract
Background
Ultrasound guidance of central venous catheter (CVC) insertion improves success rates and reduces complications and is recommended by several professional and regulatory organizations.
Methods
This is a prospective observational study using data extracted from the Central Line Emergency Access Registry database, a multicenter online registry of CVC insertions from medical centers throughout the United States. We compared success rates with ultrasound and with the anatomic-landmark technique.
Results
A total of 1250 CVC placement attempts by emergency medicine residents during the study period were selected from the Central Line Emergency Access Registry database. Because a few attempts (n = 28) were made to place lines in either the left or right supraclavicular locations, data on these attempts were eliminated from the analysis. A total of 1222 CVC attempts from 5 institutions were analyzed. Successful placement on the first attempt occurred in 1161 (86%) cases and varied according to anatomic location. Ultrasound guidance was used in 478 (41%) of the initial attempts. The remainder of placements were presumably placed using the anatomic-landmark technique based on visible surface and palpatory subcutaneous structures. Overall successful placement rate did not vary according to the use of ultrasound guidance, nor did it vary at different anatomic sites. However, ultrasound was found to be significant for reducing the total number of punctures per attempt (P < .02, t = 2.30).
Conclusions
Our study did not observe improved success with the use of ultrasound for CVC cannulation on the first attempt, but we did observe a reduced number of total punctures per attempt.
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1 Ross P. Berkeley, MD, University Medical Center Southern Nevada; Brian Levine, MD, Christiana Care Health System; Ed Panacek, MD, University of California, Davis Medical Center; Andrew Miller, DO, Lehigh Valley Hospital-Muhlenberg; Craig Norquist, MD, Scottsdale Osborn Healthcare, Scottsdale, AZ; Ralph Riviello, MD, Thomas Jefferson University Hospital, Philadelphia, PA; Roy Ary, MD, Emory University School of Medicine; Elliot Rodriguez, MD, State University of New York Upstate, Medical Center University; Janet Young, MD, University of North Carolina at Chapel Hill; Eric Gross, MD, Hennepin Country Medical Center; Lisa Mills, MD; Charity Hospital of Louisiana-LSU; Wes Zeger, DO, University of Nebraska Medical Center.
PII: S0735-6757(09)00069-2
doi:10.1016/j.ajem.2009.02.003
© 2010 Elsevier Inc. All rights reserved.
