medigraphic.com
Órgano Oficial de la Sociedad Mexicana de Angiología y Cirugía Vascular

2013, Number 1

<< Back Next >>

Rev Mex Angiol 2013; 41 (1)

Estudio aleatorizado para la comparación de la colocación de accesos vasculares centrales con y sin ayuda de ultrasonido

León-Jimeno I, Flores-Escartín M, Serrano-Lozano JA

Language: Spanish
References: 35
Page: 15-24
PDF size: 434.29 Kb.


ABSTRACT

Objective: To prove that the use of ultrasound for canulation of central vascular access guided by ultrasound in the intern jugular and the femoral veins is a safe, easy and feasible procedure. It will be intended to demonstrate that the safety of the patient increases significantly by reducing complications and morbimortality of this procedure.
Material and methods: Two groups of study were taken that included a total of 100 patients, in a sample of 50 patients the central access was obtained with anatomic marks and Seldinger technique using anterior and posterior punctions; and in the other sample of 50 patients we obtained the vascular central access guided with direct vision of the veins with ultrasound using modified Seldinger technique. The catheters that we used were: Mahurkar for hemodialysis, two and three arrow access catheters, reservoir catheters for chemotherapy and permanent hemodialysis catheters. A multifrequency of 7.5 MHZ with linear transductor ultrasound was used in the place in which the procedure was executed. These procedures were executed by Vascular Surgery, Intensive Care, General Surgery, Internal Medicine and Urgent Care Services of Hospital Regional Lic. Adolfo López Mateos of ISSSTE. Different characteristics of each patient were taken into account, the time of the procedure from the first puncture until the fixation of the catheter or tunnelization in the case of permanent catheters of reservoir for chemotherapy catheters, the number of punctures, arterial punctures, and complications were registered. All patients were taken to a chest X-ray in order to take control of complications and catheter placement in the superior cava vein. All the data was filed in a data base.
Results: The placement of central vascular access in the internal jugular and femoral veins with the help of ultrasound decreases significantly the time of the procedure from 8.74 min to 5.66 min (p ‹ 0.05), the number of arterial punctures from 3.68 to 1.28 (p ‹ 0.05) such as the complications of this procedure from 17 to 1 (p ‹ 0.05) in the group with the help of ultrasound.
Conclusions: The placement of central vascular access in the internal jugular and femoral veins is a safety, effective and easy to execute and decreases significantly the complications of this procedure increasing the patient’s safety and reducing the morbimortality inherent to these procedures in our patients.


REFERENCES

  1. McGee DC, Gould MK. Summary of Recommendations: Guidelines for the Prevention of Intravascular Catheterrelated Infections. Clin Infect Dis 2011; 52: 1087.

  2. Merrer J, De Jonghe B, Golliot F, et al. Guidelines for the Prevention of Intravascular Catheter-related Infections. Clin Infect Dis 2011; 52: e162.

  3. Bernard RW, Stahl WM. Ultrasound-guided peripheral venous cannulation using the Seldinger technique. Emerg Med J 2011; 28: 338.

  4. Sznajder JI, Zveibil FR, Bitterman H, et al. Ultrasound- Guided Catheterization of the Radial Artery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Chest 2011; 139: 524.

  5. Defalque RJ. Endovascular Treatment of an Innominate Artery Iatrogenic Pseudoaneurysm Following Subclavian Vein Catheterization. Vasc Endovascular Surg 2011; 45: 78.

  6. Goldfarb G, Lebrec D. The Use of Ultrasound to Guide Interventions: From Bench to Bedside and Back Again. Semin Cardiothorac Vasc Anesth 2010; 14: 183.

  7. Mansfield PF, Hohn DC, Fornage BD, et al. Femoral Vein Cannulation Performed by Residents: A Comparison Between Ultrasound-Guided and Landmark Technique in Infants and Children Undergoing Cardiac Surgery. Anesth Analg 2010; 111: 724.

  8. Mallory DL, McGee WT, Shawker TH, et al. Real-Time Ultrasound Guidance Facilitates Femoral Arterial Access and Reduces Vascular Complications: FAUST (Femoral Arterial Access With Ultrasound Trial). J Am Coll Cardiol Intv 2010; 3: 751.

  9. Troianos CA, Jobes DR, Ellison N. Comparison of landmark technique and ultrasound guidance for localization of long saphenous vein in infants and children. Emerg Med J 2010; 27: 443.

  10. Denys BG, Uretsky BF, Reddy PS. Brief Report: Effects of Positive End-Expiratory Pressure on Internal Jugular Vein Cross-Sectional Area in Anesthetized Adults. Anesth Analg 2010; 110: 1669.

  11. Slama M, Novara A, Safavian A, et al. Cases of Iatrogenic Pneumothorax Can Be Identified From ICD-9-CM Coded Data. Am J Med Qual 2010; 25: 218.

  12. Teichgraber UK, Benter T, Gebel M, et al. Simulation- Based Objective Assessment Discerns Clinical Proficiency in Central Line Placement: A Construct Validation. Chest 2010; 137: 1050.

  13. Nadig C, Leidig M, Schmiedeke T, et al. Analytic Reviews: Prevention of Central Venous Catheter Bloodstream Infections. J Intensive Care Med 2010; 25: 131.

  14. Hayashi H, Amano M. When Ultrasound Is Not Enough. Reply. Comment J Ultrasound Med 2010; 29: 505.

  15. Leung J, Duffy M, Finckh A. Ultrasound-Guided Femoral Dialysis Access Placement: A Single-Center Randomized Trial. CJASN 2010; 5: 235.

  16. Karakitsos D, Labropoulos N, De Groot E, et al. Coagulation Disorders in Patients with Cancer: Nontunneled Central Venous Catheter Placement with US Guidance- A Single-Institution Retrospective. Analysis Radiology 2009; 253: 249.

  17. Randolph AG, Cook DJ, Gonzales CA, et al. Video Analysis of Accidental Arterial Cannulation With Dynamic Ultrasound Guidance for Central Venous Access. J Ultrasound Med 2009; 28: 1239.

  18. Hind D, Calvert N, McWilliams R, et al. Eliminating Arterial Injury During Central Venous Catheterization Using Manometry Anesth. Analg 2009; 109: 130.

  19. Calvert N, Hind D, McWilliams RG, et al. Best choice of central venous insertion site for the prevention of catheter- related complications in adult patients who need cancer therapy: a randomized trial. Ann Oncol 2009; 20: 935.

  20. Rothschild JM. Vascular Access in Oncology Patients CA Cancer. J Clin 2008; 58: 323.

  21. Howard S. A Bedside Ultrasound in Pediatric Emergency Medicine. Pediatrics 2008; 121: e1404.

  22. Girard TD, Schectman JM. Effect of the implementation of NICE guidelines for ultrasound guidance on the complication rates associated with central venous catheter placement in patients presenting for routine surgery in a tertiary referral centre. Br J Anaesth 2007; 99: 662.

  23. Legler D, Nugent M. Central Venous Catheter Insertion: It is Finally Time to Start Looking. Anesth Analg 2007; 105: 879.

  24. Gilbert TB, Seneff MG, Becker RB. Pneumothorax after insertion of central venous catheters in the intensive care unit: association with month of year and week of month. BMJQS 2007; 16: 252.

  25. David Feller-Kopman, et al. Ultrasound-Guided Internal Jugular Access: A Proposed Standardized Approach and Implications for Training and Practice. Chest 2007; 132: 302.

  26. Bold RJ, Winchester DJ, Madary AR, et al. Gender Disparity in Failure Rate for Arterial Catheter Attempts. J Intensive Care Med 2007; 22: 166.

  27. Troianos CA, Kuwik RJ, Pasqual JR, et al. A Survey of the Use of Ultrasound During Central Venous Catheterization. Anesth Analg 2007; 104: 491.

  28. Gordon AC, Saliken JC, Johns D, et al. Central Landmark for Central Venous Catheterization. Anesth Analg 2007; 104: 216.

  29. Parry G. Ultrasound for central venous access. Contin Educ Anaesth Crit Care Pain 2005; 5: 187.

  30. Bazaral M, Harlan S. Improved Care and Reduced Costs for Patients Requiring Peripherally Inserted Central Catheters: the Role of Bedside Ultrasound and a Dedicated Team. JPEN J Parenter Enteral Nutr 2005; 29: 374.

  31. Sulek CA, Gravenstein N, Blackshear RH, et al. Should ultrasound guidance be used for central venous catheterisation in the emergency department? Emerg Med J 2005; 22: 158.

  32. Lieberman JA, Williams KA, Rosenberg AL. Circumferential Adjustment of Ultrasound Probe Position to Determine the Optimal Approach to the Internal Jugular Vein: A Noninvasive Geometric Study in Adults. Anesth Analg 2005; 100: 512.

  33. O’Grady NP, Alexander M, Dellinger EP, et al. Ultrasound- guided infraclavicular axillary vein cannulation for central venous access. Br J Anaesth 2004; 93: 188.

  34. Martin B. NICE guidelines for central venous catheterization in children. Is the evidence base sufficient? Br J Anaesth 2004; 92: 827.

  35. Mazeron JJ. Ultrasound Makes Central Line Placement Easier. J Watch General 2003; 2003: 2.




2020     |     www.medigraphic.com