The use of ultrasound for the placement of dialysis catheters

Abstract

BACKGROUND: The jugular vein should be preferred to the subclavian vein for the placement of dialysis catheters, since subclavian catheters result in a high incidence (up to 50%) of subclavian vein thromboses and stenoses. METHOD: We conducted a prospective, randomized study between July 1996 and March 1997 to find out whether through the use of ultrasound, the rate of unsuccessful attempts in puncturing the internal jugular vein could be reduced. Seventy-three internal jugular vein cannulations were performed on 65 patients, using the guide-wire technique (according to Seldinger). Two groups were formed randomly by lot: in the first group the position of the internal jugular vein was marked on the skin by the use of ultrasound (Picker CS9100, Convex 3.5 MHz) before disinfection and local anaesthesia took place. The puncture was performed according to this mark. In the second group, the internal jugular vein was cannulated with real-time ultrasound guidance on the monitor. Any withdrawal of the needle with a consecutive forward movement was judged as an unsuccessful attempt, whether or not a second skin puncture was performed. RESULT: Thirty-seven punctures of the internal jugular vein with a skin mark determined by ultrasound yielded 87 unsuccessful attempts. Thirty-six punctures with real-time ultrasound guidance resulted in 10 unsuccessful attempts (P<0.01). The time from the beginning of the local anaesthesia to successful puncture was 4.8+/-2.2 min in the first group compared to 3.4+/-0.9 min in the second group (P<0.01). The cross-section of the internal jugular vein in the first group was 1.7+/-0.8 cm2 versus 1.5+/-0.8 cm2 in the second group (not significant). Neither of the two methods caused any complications. CONCLUSION: The puncture of the internal jugular vein with real-time ultrasound guidance resulted in significantly fewer unsuccessful attempts of venepuncture without requiring additional time.