| Percutaneous central venous access for resuscitation in trauma. | |
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MedLine Citation:
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PMID: 7600399 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To determine the safety of percutaneous central venous access when used for trauma resuscitation and whether the initial hemodynamic status of the patient or the site of placement affects the ease or success of line placement. METHOD: Consecutive major-trauma patients were managed using a resuscitation protocol guiding intravenous line use. Percutaneous peripheral venous access was initially attempted in all patients. If this approach was unsuccessful or proved to be inadequate for volume resuscitation, venous access was attempted using central venous catheter-introducer sets. The site of the central venous access was determined by protocol. For thoracic injury, access was via the ipsilateral subclavian vein (SCV), the ipsilateral internal jugular vein (IJV), or the femoral vein. For suspected mediastinal injury, access was via the contralateral SCV or IJV, or the femoral vein. For abdominal or flank injury, access was via the SCV or IJV only. Multiple central venous access sites were used at the discretion of the trauma team. RESULTS: Central venous access was successful at 144 of 147 sites (99%) used in 122 patients during the study period. There was only one major complication (rate = 0.7%; 95% CI 0.0-3.8%). Mean catheter placement time was 1.9 minutes, and cannulation occurred with a mean of 1.8 needle passes. Most patients (81/122) were hypotensive (blood pressure < or = 90 torr) at the time of line placement, including 44 who were in cardiac arrest and four awake patients who had no obtainable blood pressure. Neither the access site nor the presence of hypotension was associated with the mean time to obtain central venous access, the mean number of attempts, or the complication rate. CONCLUSION: Percutaneous central venous access is relatively safe and reliable for gaining intravenous access when resuscitating trauma patients, when used in a center where physicians are experienced in the technique. Consideration should be given to expanding the use of central venous access in trauma resuscitation. |
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Authors:
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T M Scalea; R Sinert; A O Duncan; P Rice; R Austin; L Kohl; S Z Trooskin; S Talbert |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Volume: 1 ISSN: 1069-6563 ISO Abbreviation: Acad Emerg Med Publication Date: 1994 Nov-Dec |
Date Detail:
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Created Date: 1995-08-10 Completed Date: 1995-08-10 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9418450 Medline TA: Acad Emerg Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 525-31 Citation Subset: IM |
Affiliation:
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Department of Emergency Medicine and Surgery, SUNY Health Science Center at Brooklyn, USA. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Bloodletting / adverse effects, methods* Catheterization, Central Venous / methods* Clinical Protocols Female Femoral Vein Hemodynamics Humans Jugular Veins Male Prospective Studies Resuscitation Subclavian Vein Time Factors Wounds and Injuries / physiopathology, therapy* |
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