ULTRASOUND-GUIDED CANNULATION OF THE FEMORAL VEIN FOR ACUTE HEMODIALYSIS ACCESS

Background. Central venous access is a mandatory part of patient manag ement in many clinical settings and is usually achieved with a blind, external landmark-guided technique. The purpose of this study is to ev aluate whether an ultrasound technique can improve on the external lan dmark method. Methods. We prospectively evaluated an ultrasound-guided method in 28 patients undergoing femoral vein cannulation for acute h aemodialysis access and compared the results with 38 patients in whom an external landmark-guided technique was used. External landmark-guid ed technique was done by manual localization of the femoral artery in the femoral triangle inferior to the inguinal ligament with needle ins ertion medial to the artery. Ultrasound-guided cannulation was perform ed in the same location with the aid of an ultrasound device (Site-Rit e, Dymax Corp., USA) with a 7.5 MHz transducer covered by a sterile sh eath. Results. Cannulation of the femoral vein was achieved in all pat ients (100%) using ultrasound and in 34 patients (89.5%) using the lan dmark-guided technique. The vein was entered on the first attempt in 9 2.9% of patients using ultrasound and in 55.3% using the landmark tech nique (P < 0.05). Average access time (skin to vein) was similar but t otal procedure time was 45.1 +/- 18.8 s by the ultrasound approach and 79.4 +/- 61.7 s by the landmark approach (P < 0.05). Using ultrasound , puncture of the femoral artery occurred in 7.1% of patients, and hae matoma in O%. Using external landmark technique, puncture of the femor al artery occurred in 15.8% of patients, and haematoma in 2.6%. Conclu sions. Ultrasound-guided cannulation of the femoral vein reduces the t ime required for the procedure, reduces the number of passes needed to puncture the vein, and minimizes complications such as arterial punct ure or haematoma.