Central venous catheterization

Taylor, Robert W.; Palagiri, Ashok

doi:10.1097/01.ccm.0000260241.80346.1b

Cited by 231 publications

(167 citation statements)

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“…The current gold standard technique for measuring CVP requires an invasive central venous catheter, which can delay timely resuscitation and is associated with complications. 6 An alternative technique to guide resuscitation efforts should be accurate, safe, rapid, and easy to perform at the bedside, while providing real-time measurement results. We hypothesized that CVP can be accurately assessed using noninvasive ultrasound imaging of the internal jugular vein, since jugular venous pressure is essentially equal to CVP.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of a simple ultrasound measurement to estimate central venous pressure in spontaneously breathing, critically ill patients

Keller

Melamed

Malinchoc

et al. 2009

Journal of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of a simple ultrasound measurement to estimate central venous pressure in spontaneously breathing, critically ill patients

Keller

Melamed

Malinchoc

et al. 2009

Journal of Hospital Medicine

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“…Its use is important in the care of those who are acutely or critically ill and those who are chronically ill. CVC is associated with a number of potentially serious mechanical complications, including arterial puncture, pneumothorax, and death. 11,17 Proficiency in CVC insertion is found to be closely related to operator experience: catheter insertion by physicians who have performed 50 or more CVC are one-half as likely to sustain complications as catheter insertion by less experienced physicians. 18 Furthermore, training has been found to be associated with a decrease in risk for catheter associated infection 19 and pneumothorax.…”

Section: Discussionmentioning

confidence: 99%

Improving internal medicine residents' performance, knowledge, and confidence in central venous catheterization using simulators

Millington

Wong

Kassen

et al. 2009

Journal of Hospital Medicine

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BACKGROUND:Efficacy of simulators in teaching central venous catheterization (CVC) in an internal medicine residency program is unknown.OBJECTIVE:To determine whether or not learning CVC on simulators is associated with improvement in performance of CVC, knowledge about the procedure, and self‐reported confidence.METHODS:All consenting first‐year internal medicine residents who completed training in CVC on simulators were included. Participants were evaluated pre‐ and post‐training by video‐recorded CVC insertion and multiple‐choice knowledge assessments. Procedural technique was rated in a blinded fashion by two independent adjudicators. Knowledge retention and self‐reported confidence were reassessed at 18 months.MEASUREMENTS:Primary outcome of CVC performance was assessed based on global rating score (minimum 1, maximum 5). Secondary measures include checklist score (out of ten), knowledge score and self‐reported confidence (6‐point Likert scale ranging from “none” to “complete”).RESULTS:Median global rating scores in 30 participants increased from 3.5 (IQR = 3‐4) to 4.5 (IQR = 4‐4.5) (P < 0.001). Checklist score increased from 9 (IQR = 6‐9.5) to 9.5 (IQR = 9‐9.5) (P < 0.001). Knowledge score increased from 65.7 ± 11.9% to 81.2 ± 10.7% (P < 0.001). Confidence increased from 3 (“moderate”, IQR = 2‐3) to 4 (“good”, IQR=3‐4) (P < 0.001). Sixteen participants completed the retention tests. Improvement in knowledge score and confidence at 18 months was retained compared with baseline (P = 0.002 and P < 0.0001 respectively).CONCLUSIONS:Use of simulators in teaching CVC in an internal medicine residency program results in improved procedural performance, knowledge, and self‐reported confidence. Improvement in knowledge and confidence was retained at 18 months. Journal of Hospital Medicine 2009;4:410–416. © 2009 Society of Hospital Medicine.

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“…For this reason, a chest X-ray is advisable to verify the position of the catheter tip and exclude the possibility of iatrogenic pneumothorax (PTX) [48]. The presence of the catheter tip in the right atrium is reported in 8-47 % of cases; even in expert hands, placement error rates range from 6 to 14 % [49].…”

Section: Diagnosing Complications Of Central Venous Catheterizationmentioning

confidence: 99%

Ultrasonography as a guide during vascular access procedures and in the diagnosis of complications

et al. 2013

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Vascular access used in the treatment of patients involves central and peripheral vein accesses and arterial accesses. Catheterization of central veins is widely used in clinical practice; it is a necessary part of the treatment of patients in various settings. The most commonly involved vessels are the internal jugular, subclavian, and femoral veins. The mechanical, infectious, and thrombotic complications of central venous catheterization are markedly reduced when the procedure is performed with real-time ultrasound guidance or (to a slightly lesser extent) ultrasound assistance. Ultrasound guidance is also used to create peripheral venous accesses, for catheterization of peripheral veins and for peripheral insertion of central venous catheters. In this setting, it increases the catheterization success rate, especially during difficult procedures (e.g., obese patients, children) and reduces complications such as catheter-related infections and venous thrombosis. Arterial cannulation is used for invasive monitoring of arterial pressure and for access during diagnostic or therapeutic procedures. Ultrasound guidance reduces the risk of catheterization failure and complications. It is especially useful for arterial catheterization procedures performed in the absence of a palpable pulse (e.g., patient in shock, ECMO). Imaging support is being used increasingly to facilitate the creation of vascular accesses under difficult conditions, in part because of the growing use of ultrasonography as a bedside procedure. In clinical settings where patients are becoming increasingly vulnerable as a result of advanced age and/or complex disease, the possibility to reduce the risks associated with these invasive procedures should motivate clinicians to acquire the technical skills needed for routine use of sonographic support during vascular access procedures. Keywords Vascular access Á UltrasoundRiassunto Gli accessi vascolari utilizzati nella cura dei pazienti comprendono gli accessi venosi centrali e periferici e gli accessi arteriosi. L'incannulamento di accessi venosi centrali è manovra largamente diffusa nella pratica clinica e si rende necessaria per la cura dei pazienti in molteplici contesti. I vasi centrali che usualmente vengono incannulati sono la vena giugulare interna, la vena succlavia e la vena femorale. Nell'incannulamento venoso centrale sia l'eco-assistenza che l'eco-guida real time, pur con una leggera superiorità di quest'ultima, riducono drasticamente le complicanze meccaniche, infettive e trombotiche. La guida ecografica viene utilizzata anche per l'accesso venoso periferico, per l'incannulamento di vasi periferici e di vasi centrali a inserzione periferica (PICC). In questo contesto la guida ecografica aumenta il successo della manovra di incannulamento soprattutto in condizioni di difficoltà, come avviene nei pazienti obesi o nei bambini, e diminuisce le complicanze quali le infezioni catetere correlate e le trombosi venose. L'incannulamento arterioso viene utilizzato per il monitoraggio cruent...

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Central venous catheterization

Abstract: Appropriate catheter and site selection, sufficient operator experience, careful technique, and proper catheter maintenance with removal as soon as possible are associated with optimal outcome.

Cited by 231 publications

References 100 publications

Diagnostic accuracy of a simple ultrasound measurement to estimate central venous pressure in spontaneously breathing, critically ill patients

Diagnostic accuracy of a simple ultrasound measurement to estimate central venous pressure in spontaneously breathing, critically ill patients

Improving internal medicine residents' performance, knowledge, and confidence in central venous catheterization using simulators

Ultrasonography as a guide during vascular access procedures and in the diagnosis of complications

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