Th. Kwon et al., ULTRASOUND-GUIDED CANNULATION OF THE FEMORAL VEIN FOR ACUTE HEMODIALYSIS ACCESS, Nephrology, dialysis, transplantation, 12(5), 1997, pp. 1009-1012
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.