Background: Portable ultrasound machines are highly valuable in ICUs,
where a patient's condition might not permit shifting the patient to
the USG department for imaging. Traditionally central lines are put
blindly using anatomical landmarks, which often result in complications
such as difficulty in access, misplaced lines, pneumothorax, bleeding
from inadvertent arterial punctures, etc. Ultrasonography provides
"real time" imaging, i.e., the needle can be visualized entering the
vein. Aims: We performed a study to compare USG guided central venous
cannulation (CVC) and conventional anatomical landmark approach to CVC,
in terms of ease of cannulation, time consumed, and associated
complications. Settings and Design: The study was performed in a 16-bed
open ICU. Eighty patients were randomly divided in two groups.
Materials and Methods: The right internal jugular vein (IJV) was
cannulated in all. In Group I, a portable ultrasound machine was used
during cannulation. The vessels were visualized in the transverse
section with the internal carotid artery (ICA) identified as a circular
pulsatile structure, while the IJV as a lateral, oval nonpulsatile
structure). The needle was inserted perpendicular to the skin under
visualization on the US screen. Central venous line was then inserted
by the Seldinger technique. In Group II, CVC was performed by the
conventional landmark approach. The parameters studied included time
for insertion, attempts required, and complications
encountered.Statistical Analysis: The database of all parameters was
analyzed using SPSS software version 10.5. Results: The mean time to
successful insertion was 145 and 176.4 sec in groups I and II,
respectively (p = 0.00). An average of 1.2 attempts per cannulation was
required for group I, while 1.53 for group II (p = 0.03): 10% witnessed
arterial puncture and 2.5% pneumothorax in group I and none in group
II. Conclusion: USG-guided CVC is thus easier, quicker, and safer than
landmark approach
