PULSED DOPPLER SONOGRAPHY FOR THE GUIDANCE OF VEIN PUNCTURE - A PROSPECTIVE-STUDY

Blind deep venous puncture is an invasive procedure with risks of seri ous complications compromising the availability of veins for future pu nctures or endangering the patient's life. We designed a new hand-held pulsed Doppler probe for coaxial guidance of the puncture needle and a dedicated pulsed Doppler device displaying the depth of the measurem ent volume. We used this technique prospectively in two independent ce nters (the nephrology department and the intensive care unit) involvin g senior as well as junior staff members. Either the non-Doppler or th e Doppler method were randomly selected for subclavian vein catheteriz ation in 100 patients and for internal jugular vein catheterization in 30 patients. The success rate on the first attempt was 86.2% for the non-Doppler method versus 96.8% for the Doppler method (p = 0.03). The failure rate of the non-Doppler method used by junior staff members w as 9.2%, reduced to 1.5% (p = 0.05) by secondary use of the Doppler me thod and/or help from a senior staff member (rescue procedure). Pulsed Doppler guidance reduced significantly the failure rate of venous pun ctures especially when used by seniors or by juniors after a training period.