Apresentação

Real-time ultrasound-guided internal jugular vein catheterization in the ICU

ROSELAINE PINHEIRO DE OLIVEIRA, TULIO FREDERICO TONIETTO, CÍNTIA ROEHRIG, JUCARA GASPARETTO MACCARI, EUBRANDO SILVESTRE OLIVEIRA, CASSIANO TEIXEIRA, RICARDO VIEGAS CREMONESE, FLAVIO ANDRE CARDONA ALVES, SERGIO FERNANDO MONTEIRO BRODT, FELIPPE LEOPOLDO DEXHEIMER NETO, NILTON BRANDAO DA SILVA

Em: ESICM 22nd Annual Congress Viena, 2009, Viena. (Poster Eletrônico)

Motivo: Produção Colaborador HMV

Setor HMV: CTI Adulto

Área da saúde: Medicina Intensiva

Resumo: INTRODUCTION. Central venous catheterization (CVC) is often necessary to treat critically ill patients. However, this procedure can lead to serious and sometimes life-treating complications. Several studies showed a clear benefit from two-dimensional ultrasound guidance for CVC compared with landmark method supporting the idea that it should be part of the routine care and being recommended by the Agency for Healthcare Research and Quality (USA) and by the National Institute of Clinical Excellence (UK). OBJECTIVES. To determine the success rate, the number of attempts and the number of complications of real-time ultrasound-guided cannulation of the internal jugular vein, done by ICU physicians. METHODS. Prospective study, single-center consecutive case series evaluating critically ill adult patients, admitted in a 31-bed general ICU requiring cannulation of internal jugular vein. Catheterization was performed using real-time ultrasound guidance with all patients. The baseline characteristics were evaluated, as well as the presence of risk factors for difficult venous cannulation such as shock, untreated coagulopathy, mechanical ventilation, prior catheterization, previous difficulties during catheterization, vessel's size and position, catheter size and kind (central venous, haemodialysis or pulmonary artery catheter), number of attempts and operator experience. RESULTS. 65 patients were included (30 male) with a median age of 71±16 yr, the Body Mass Index (BMI) was 27±6 kg/m2 and the median catheter in place was 7±6 days. 53% were in mechanical ventilation. Internal jugular vein cannulation was successful in 89% patients. Jugular cannulation was successful at the first attempt in 49 patients (79%). Among the risk factors for failures of cannulation, previous catheter (60% vs. 40%, p=0.007) and more than one the needle passes (86% v. 14%, p< 0.001) were associated with failure. We found a low rate of complications (3,5%), one arterial puncture and 1 neck haematoma. CONCLUSIONS. Ultrasound guidance for jugular vein cannulation was safe and feasible in ICU patients. Our results suggest that ultrasound guidance could be used by ICU physicians with low complications, similar to the results in the literature.

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