Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit
OBJECTIVE:To determine whether ultrasound (US) increases successful central venous catheter (CVC) placement, decreases site attempts, and decreases CVC placement complications. DESIGN AND SETTING:A prospective observational cohort study evaluating a transition by the Pediatric Critical Care Medicine...
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| Veröffentlicht in: | Critical care medicine 2009-03, Vol.37 (3), p.1090-1096 |
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| creator | Froehlich, Curt D Rigby, Mark R Rosenberg, Eli S Li, Ruosha Roerig, Pei-Ling J Easley, Kirk A Stockwell, Jana A |
| description | OBJECTIVE:To determine whether ultrasound (US) increases successful central venous catheter (CVC) placement, decreases site attempts, and decreases CVC placement complications.
DESIGN AND SETTING:A prospective observational cohort study evaluating a transition by the Pediatric Critical Care Medicine service to US-guided CVC placement. Medical and surgical patients in a 21-bed quaternary multidisciplinary pediatric intensive care unit had CVCs placed by attendings, fellows, residents, and a nurse practitioner.
PATIENTS:Ninety-three patients were prospectively enrolled into the landmark (LM) group and 119 into the US group.
INTERVENTIONS:After collection of prospective LM data, training with US guidance was provided. CVCs were subsequently placed with US guidance.
MEASUREMENTS AND MAIN RESULTS:Operator information, disease process, emergent/routine, sites attempted, and complications were recorded. Procedure time was from initial skin puncture to guidewire placement. There was no difference overall in success rates (88.2% LM vs. 90.8% US, p = 0.54) or time to successful placement (median seconds 269 LM vs. 150 US, p = 0.14) between the two groups. Median number of attempts were fewer with US for all CVCs attempted (3 vs. 1, p < 0.001) as were attempts at >1 anatomical site (20.7% LM vs. 5.9% US, p = 0.001). Use of US was associated with fewer inadvertent artery punctures (8.5% vs. 19.4%, p = 0.03). Time to successful placement by residents was decreased with US (median 919 seconds vs. 405 seconds, p = 0.02). More internal jugular CVCs were placed during the US period than during the LM period (13.4% vs. 2.1%).
CONCLUSIONS:US-guided CVC placement in children is associated with decreased number of anatomical sites attempted and decreased number of attempts to gain placement. Time to placement by residents was decreased with US, but not the time to placement by other operators. US guidance increased the use of internal jugular catheter placement and decreased artery punctures. US guidance did not improve success rates. |
| doi_str_mv | 10.1097/CCM.0b013e31819b570e |
| format | Article |
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DESIGN AND SETTING:A prospective observational cohort study evaluating a transition by the Pediatric Critical Care Medicine service to US-guided CVC placement. Medical and surgical patients in a 21-bed quaternary multidisciplinary pediatric intensive care unit had CVCs placed by attendings, fellows, residents, and a nurse practitioner.
PATIENTS:Ninety-three patients were prospectively enrolled into the landmark (LM) group and 119 into the US group.
INTERVENTIONS:After collection of prospective LM data, training with US guidance was provided. CVCs were subsequently placed with US guidance.
MEASUREMENTS AND MAIN RESULTS:Operator information, disease process, emergent/routine, sites attempted, and complications were recorded. Procedure time was from initial skin puncture to guidewire placement. There was no difference overall in success rates (88.2% LM vs. 90.8% US, p = 0.54) or time to successful placement (median seconds 269 LM vs. 150 US, p = 0.14) between the two groups. Median number of attempts were fewer with US for all CVCs attempted (3 vs. 1, p < 0.001) as were attempts at >1 anatomical site (20.7% LM vs. 5.9% US, p = 0.001). Use of US was associated with fewer inadvertent artery punctures (8.5% vs. 19.4%, p = 0.03). Time to successful placement by residents was decreased with US (median 919 seconds vs. 405 seconds, p = 0.02). More internal jugular CVCs were placed during the US period than during the LM period (13.4% vs. 2.1%).
CONCLUSIONS:US-guided CVC placement in children is associated with decreased number of anatomical sites attempted and decreased number of attempts to gain placement. Time to placement by residents was decreased with US, but not the time to placement by other operators. US guidance increased the use of internal jugular catheter placement and decreased artery punctures. US guidance did not improve success rates.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0b013e31819b570e</identifier><identifier>PMID: 19237922</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Catheterization, Central Venous - adverse effects ; Catheterization, Central Venous - methods ; Child, Preschool ; Clinical death. Palliative care. Organ gift and preservation ; Critical Care - methods ; Humans ; Intensive care medicine ; Intensive Care Units, Pediatric ; Medical sciences ; Prospective Studies ; Ultrasonography</subject><ispartof>Critical care medicine, 2009-03, Vol.37 (3), p.1090-1096</ispartof><rights>2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3802-60b0ac832870b8fbce420b72125e2f3c169e020f5856497092bcf77a247614e03</citedby><cites>FETCH-LOGICAL-c3802-60b0ac832870b8fbce420b72125e2f3c169e020f5856497092bcf77a247614e03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21243298$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19237922$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Froehlich, Curt D</creatorcontrib><creatorcontrib>Rigby, Mark R</creatorcontrib><creatorcontrib>Rosenberg, Eli S</creatorcontrib><creatorcontrib>Li, Ruosha</creatorcontrib><creatorcontrib>Roerig, Pei-Ling J</creatorcontrib><creatorcontrib>Easley, Kirk A</creatorcontrib><creatorcontrib>Stockwell, Jana A</creatorcontrib><title>Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVE:To determine whether ultrasound (US) increases successful central venous catheter (CVC) placement, decreases site attempts, and decreases CVC placement complications.
DESIGN AND SETTING:A prospective observational cohort study evaluating a transition by the Pediatric Critical Care Medicine service to US-guided CVC placement. Medical and surgical patients in a 21-bed quaternary multidisciplinary pediatric intensive care unit had CVCs placed by attendings, fellows, residents, and a nurse practitioner.
PATIENTS:Ninety-three patients were prospectively enrolled into the landmark (LM) group and 119 into the US group.
INTERVENTIONS:After collection of prospective LM data, training with US guidance was provided. CVCs were subsequently placed with US guidance.
MEASUREMENTS AND MAIN RESULTS:Operator information, disease process, emergent/routine, sites attempted, and complications were recorded. Procedure time was from initial skin puncture to guidewire placement. There was no difference overall in success rates (88.2% LM vs. 90.8% US, p = 0.54) or time to successful placement (median seconds 269 LM vs. 150 US, p = 0.14) between the two groups. Median number of attempts were fewer with US for all CVCs attempted (3 vs. 1, p < 0.001) as were attempts at >1 anatomical site (20.7% LM vs. 5.9% US, p = 0.001). Use of US was associated with fewer inadvertent artery punctures (8.5% vs. 19.4%, p = 0.03). Time to successful placement by residents was decreased with US (median 919 seconds vs. 405 seconds, p = 0.02). More internal jugular CVCs were placed during the US period than during the LM period (13.4% vs. 2.1%).
CONCLUSIONS:US-guided CVC placement in children is associated with decreased number of anatomical sites attempted and decreased number of attempts to gain placement. Time to placement by residents was decreased with US, but not the time to placement by other operators. US guidance increased the use of internal jugular catheter placement and decreased artery punctures. US guidance did not improve success rates.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Catheterization, Central Venous - adverse effects</subject><subject>Catheterization, Central Venous - methods</subject><subject>Child, Preschool</subject><subject>Clinical death. Palliative care. Organ gift and preservation</subject><subject>Critical Care - methods</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units, Pediatric</subject><subject>Medical sciences</subject><subject>Prospective Studies</subject><subject>Ultrasonography</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUsmO1DAQjRCIaQb-ACFf4JahvCSOj6jFJg3iwpwjx6kQM86C7UyLv-PTqFa3aIQlyy7Xe7U9F8VLDjccjH6733-5gQ64RMkbbrpKAz4qdrySUIIw8nGxAzBQSmXkVfEspR8AXFVaPi2uuBFSGyF2xe-7kKNNyzb35ffN99gzhzM9BfaA87Il5mweMWNka7AOJ3KyHl1Em5Ccy7QGTxC_zInZuf_Hd8HbnHFa8wluI-U4-DwyissCcSYb71lGN87-54bMz2ylgERMx7tlK_be5ugdmRnn5B-QqorIttnn58WTwYaEL87ndXH34f23_afy9uvHz_t3t6WTDYiyplFZ10jRaOiaoXOoBHRacFGhGKTjtUEQMFRNVSujwYjODVpboXTNFYK8Lt6c4q5xoSpTbiefHAZqAGlMbV2bSgqoCahOQBeXlCIO7Ro9tfir5dAelWtJufZ_5Yj26hx_6ybsL6SzVAR4fQbY5GwYop2dT39x1ImSwjSX_IclkGzpPmwHjO2INuSxBVpSqLoUx88hySppKyH_AKUptso</recordid><startdate>200903</startdate><enddate>200903</enddate><creator>Froehlich, Curt D</creator><creator>Rigby, Mark R</creator><creator>Rosenberg, Eli S</creator><creator>Li, Ruosha</creator><creator>Roerig, Pei-Ling J</creator><creator>Easley, Kirk A</creator><creator>Stockwell, Jana A</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200903</creationdate><title>Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit</title><author>Froehlich, Curt D ; Rigby, Mark R ; Rosenberg, Eli S ; Li, Ruosha ; Roerig, Pei-Ling J ; Easley, Kirk A ; Stockwell, Jana A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3802-60b0ac832870b8fbce420b72125e2f3c169e020f5856497092bcf77a247614e03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Catheterization, Central Venous - adverse effects</topic><topic>Catheterization, Central Venous - methods</topic><topic>Child, Preschool</topic><topic>Clinical death. Palliative care. Organ gift and preservation</topic><topic>Critical Care - methods</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units, Pediatric</topic><topic>Medical sciences</topic><topic>Prospective Studies</topic><topic>Ultrasonography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Froehlich, Curt D</creatorcontrib><creatorcontrib>Rigby, Mark R</creatorcontrib><creatorcontrib>Rosenberg, Eli S</creatorcontrib><creatorcontrib>Li, Ruosha</creatorcontrib><creatorcontrib>Roerig, Pei-Ling J</creatorcontrib><creatorcontrib>Easley, Kirk A</creatorcontrib><creatorcontrib>Stockwell, Jana A</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Froehlich, Curt D</au><au>Rigby, Mark R</au><au>Rosenberg, Eli S</au><au>Li, Ruosha</au><au>Roerig, Pei-Ling J</au><au>Easley, Kirk A</au><au>Stockwell, Jana A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2009-03</date><risdate>2009</risdate><volume>37</volume><issue>3</issue><spage>1090</spage><epage>1096</epage><pages>1090-1096</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVE:To determine whether ultrasound (US) increases successful central venous catheter (CVC) placement, decreases site attempts, and decreases CVC placement complications.
DESIGN AND SETTING:A prospective observational cohort study evaluating a transition by the Pediatric Critical Care Medicine service to US-guided CVC placement. Medical and surgical patients in a 21-bed quaternary multidisciplinary pediatric intensive care unit had CVCs placed by attendings, fellows, residents, and a nurse practitioner.
PATIENTS:Ninety-three patients were prospectively enrolled into the landmark (LM) group and 119 into the US group.
INTERVENTIONS:After collection of prospective LM data, training with US guidance was provided. CVCs were subsequently placed with US guidance.
MEASUREMENTS AND MAIN RESULTS:Operator information, disease process, emergent/routine, sites attempted, and complications were recorded. Procedure time was from initial skin puncture to guidewire placement. There was no difference overall in success rates (88.2% LM vs. 90.8% US, p = 0.54) or time to successful placement (median seconds 269 LM vs. 150 US, p = 0.14) between the two groups. Median number of attempts were fewer with US for all CVCs attempted (3 vs. 1, p < 0.001) as were attempts at >1 anatomical site (20.7% LM vs. 5.9% US, p = 0.001). Use of US was associated with fewer inadvertent artery punctures (8.5% vs. 19.4%, p = 0.03). Time to successful placement by residents was decreased with US (median 919 seconds vs. 405 seconds, p = 0.02). More internal jugular CVCs were placed during the US period than during the LM period (13.4% vs. 2.1%).
CONCLUSIONS:US-guided CVC placement in children is associated with decreased number of anatomical sites attempted and decreased number of attempts to gain placement. Time to placement by residents was decreased with US, but not the time to placement by other operators. US guidance increased the use of internal jugular catheter placement and decreased artery punctures. US guidance did not improve success rates.</abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>19237922</pmid><doi>10.1097/CCM.0b013e31819b570e</doi><tpages>7</tpages></addata></record> |
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| ispartof | Critical care medicine, 2009-03, Vol.37 (3), p.1090-1096 |
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| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Catheterization, Central Venous - adverse effects Catheterization, Central Venous - methods Child, Preschool Clinical death. Palliative care. Organ gift and preservation Critical Care - methods Humans Intensive care medicine Intensive Care Units, Pediatric Medical sciences Prospective Studies Ultrasonography |
| title | Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit |
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