Nephrology Dialysis Transplantation, Vol 13, Issue 4 978-981, Copyright © 1998 by Oxford University Press
C Nadig, M Leidig, T Schmiedeke and B Hoffken
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. 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.
Key words: central venous catheterization; jugular
vein; ultrasound
TECHNICAL NOTES
The use of ultrasound for the placement of dialysis catheters
Department of Medicine IV of the University of Erlangen-Nuremberg, Germany; Corresponding author at: alte Landstrasse 30, CH-8803 Ruschlikon, Switzerland
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