Ultrasound-Guided Central Venous Cannulation in Bariatric Patients

Abstract

The use of ultrasound guidance may increase the success rate and decrease the incidence of complications associated with central venous cannulation. The advantages of this approach is visualization of the anatomical structures at puncture site prior to skin puncture and the ability to track needle and guide-wire placement during the procedure. With its high accuracy in detecting catheter misplacement, bedside ultrasonic examination combined with intraatrial electrocardiogram may further decrease morbidity associated with misplaced central venous catheters.

Perioperative management of the severely obese patient: a selective pathophysiological review

“…The use of ultrasound guidance for central venous catheter insertion may overcome vein location issues, lower the risk of arterial puncture, and reduce the time it takes for insertion as expertise increases. Ultrasound has been shown to aid in the safe placement of internal jugular lines, 75 and it may also be used to guide peripheral venous access 76 and arterial access. Not surprisingly, compared with non-obese patients, obesity can hinder the ultrasound view of the subclavian vein, 77 and novices should not attempt unsupervised ultrasound-guided subclavian line insertion in this patient group.…”

Accuracy of Vigileo/Flotrac monitoring system in morbidly obese patients

“…In MO, central venous access could be particularly difficult, although this obstacle has been partly solved by echography [28,29]. Furthermore, the invasiveness of PAC TD is not justified with improved outcomes [10,11], and it has significant direct patient risk such as malignant arrhythmias [30,31], pulmonary artery rupture [32], and death [33].…”

Which Intraoperative Monitors are Essential for the Obese Surgical Patient?

“…Anatomic variability of internal jugular veins is frequent in obese patients and the common diminished vein diameter (\10 mm) may cause difficulty with placement [11]. Catheters are often positioned after induction of anesthesia, but obtaining a chest X-ray to check for correct placement and the absence of pneumothorax is usually delayed until the end of surgery.…”

“…Catheters are often positioned after induction of anesthesia, but obtaining a chest X-ray to check for correct placement and the absence of pneumothorax is usually delayed until the end of surgery. Ultrasound guidance increases the success of placement and decreases the incidence of complications [11,12].…”