FACILITATION OF INTERNAL JUGULAR VENOUS CANNULATION USING AN AUDIO-GUIDED DOPPLER ULTRASOUND VASCULAR ACCESS DEVICE - RESULTS FROM A PROSPECTIVE, DUAL-CENTER, RANDOMIZED, CROSSOVER CLINICAL-STUDY
Tb. Gilbert et al., FACILITATION OF INTERNAL JUGULAR VENOUS CANNULATION USING AN AUDIO-GUIDED DOPPLER ULTRASOUND VASCULAR ACCESS DEVICE - RESULTS FROM A PROSPECTIVE, DUAL-CENTER, RANDOMIZED, CROSSOVER CLINICAL-STUDY, Critical care medicine, 23(1), 1995, pp. 60-65
Objective: To determine the utility of an audio-guided Doppler ultraso
und device in improving success and decreasing complications in cannul
ation of the internal jugular vein in high-risk patients. Design: Pros
pective, randomized, crossover clinical study. Setting: Two major univ
ersity medical centers in critical care environments. Patients: Sevent
y-six consecutive, consenting adult patients with preexisting obesity
or coagulopathy requiring central venous access. Interventions: Subjec
ts enrolled in the study were randomized to receive either the traditi
onal ''blind'' (control) technique or the ultrasonic technique. A maxi
mum of three cannulation attempts were allowed before crossover to thr
ee attempts with the alternative technique. All cannulations were atte
mpted via the internal jugular vein through a high/central approach. R
esults: Patient and operator characteristics were similar between grou
ps. The initial use of an audio-guided ultrasound device was associate
d with increased success of cannulation (84.4% vs, 61.4%; p < .05) and
decreased need to crossover to the alternative technique. Success on
the first needle pass was more likely with the ultrasound technique (5
6.3% vs. 29.5%; p < .05). Significant complications were greater with
the control technique (carotid artery puncture 16.3% vs. 2.0% [p < .02
]; any significant complication 26.5% vs. 6.1% [p < .01]). Conclusions
: The use of an audio-guided Doppler ultrasound vascular access device
was associated with increased success of cannulation and a decreased
frequency of significant complications in a population of high-risk pa
tients with obesity or coagulopathy.