Document Detail


A randomized controlled clinical trial of real-time needle-guided ultrasound for internal jugular venous cannulation in a large university anesthesia department.
MedLine Citation:
PMID:  16130056     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to evaluate needle-guided ultrasound for internal jugular venous cannulation in a large university anesthesia department, to determine cumulative cannulation success by method, to determine first-pass cannulation success by method and operator, and to determine arterial puncture by method and operator. STUDY DESIGN: Prospective, observational, and randomized. Blinding was not possible. Cohort size was calculated for 80% power to detect a technique difference, with significance defined as p < 0.05. SETTING: Operating rooms of the Hospital of the University of Pennsylvania. PARTICIPANTS: Elective surgical patients requiring internal jugular venous cannulation. INTERVENTIONS: Cannulation of the internal jugular vein occurred by needle-guided ultrasound (NGU) or by ultrasound without a needle guide. MAIN RESULTS: Four hundred thirty-four procedures were studied in 429 patients. NGU significantly enhances cannulation success after first (68.9%-80.9%, p = 0.0054) and second (80.0%-93.1%, p = 0.0001) needle passes. Cumulative cannulation success by the seventh needle pass is 100%, regardless of technique. The needle-guide specifically improves first-pass success in the junior operator (65.6%-79.8%, p = 0.0144). Arterial puncture averages 4.2%, regardless of technique (p > 0.05) or operator (p > 0.05). CONCLUSIONS: Although the needle guide facilitates prompt cannulation with ultrasound in the novice operator, it offers no additional protection against arterial puncture. This may be because of a lack of control of needle depth rather than needle direction. A possible solution may be biplanar ultrasound for central venous cannulation.
Authors:
John G Augoustides; Jiri Horak; Andrew E Ochroch; William J Vernick; Andrew J Gambone; Justin Weiner; Dawn Pinchasik; Deborah Kowalchuk; Joseph S Savino; David R Jobes
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  19     ISSN:  1053-0770     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2005 Jun 
Date Detail:
Created Date:  2005-08-30     Completed Date:  2006-01-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  310-5     Citation Subset:  IM    
Affiliation:
Department of Anesthesia, Cardiothoracic Section, Hospital of the University of Pennsylvania, PA 19104, USA. yiandoc@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Anesthesia Department, Hospital*
Catheterization, Central Venous / adverse effects,  instrumentation*,  methods
Cohort Studies
Hospitals, University*
Humans
Intraoperative Complications / etiology
Jugular Veins / ultrasonography*
Needles*
Prospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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