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Published on: December 23, 2014
Quality improvement: ultrasonography-guided venous catheterization in organ transplantation
1Department of Anaesthesiology and Reanimation, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain. asabatep@bellvitgehospital.cat
Insights
Ultrasonography-guided central venous catheterization (CVC) improves success rates, especially for high-risk patients. This technique is easily learned for internal jugular vein cannulation, enhancing patient safety and procedural outcomes.
Area of Science:
- Medical Procedures
- Vascular Access
- Diagnostic Imaging
Background:
- Central venous catheterization (CVC) carries inherent risks, particularly in high-risk patient populations like transplant recipients.
- Accurate vein localization is crucial for safe and effective CVC insertion.
- Anatomical variations and vessel pathologies can complicate CVC procedures.
Purpose of the Study:
- To review the clinical evidence and technical skills for ultrasonography-guided CVC.
- To provide basic training guidelines for ultrasound-guided vascular catheterization.
- To highlight the benefits of ultrasonography in overcoming challenges in CVC procedures.
Main Methods:
- Review of clinical evidence on ultrasonography-guided CVC.
- Description of technical skills required for the procedure.
- Analysis of common target veins and access approaches.
Main Results:
- Internal jugular vein is the recommended target for learning ultrasonography-guided CVC due to ease and safety.
- Distal (deltoid) access for subclavian-axillary vein insertion and supraclavicular access in pediatric patients are effective.
- Anatomical variations, small vessel size, and surrounding edema are key factors in CVC failure.
Conclusions:
- Ultrasonography-guided venous catheterization is a readily learnable technique.
- Internal jugular vein cannulation using ultrasound significantly improves success rates.
- This method is particularly beneficial for patients with anticipated difficult venous access.
Purpose Of Review:
Central venous catheterization (CVC) is a procedure, not exempt of risk. Transplantation patients represent by themselves a high-risk group for CVC. Ultrasonography provides us of the exact localization of the target vein and its relationship with artery and nerve structures, detecting anatomic variations and thromboses of vessels. A description of technical skills, a review of the clinical evidence of ultrasonography-guided CVC and basic training guidelines are presented.
Recent Findings:
The internal jugular vein is the most common target vein selected because it is easier and safer, therefore it is the target vein recommended for learning the ultrasonography procedure. For subclavian-axillar vein insertion, the more distal (deltoid) access is the preferred approach; the supraclavicular access has been described with high success in paediatric patients. Anatomic variations of the venous system are not uncommon; small size, overlap artery and tissue oedema around the neck are the main causes of CVC failure. Training guidelines for ultrasound-guided vascular catheterization are necessary, and skill maintenance is crucial.
Summary:
Ultrasonography-guided venous catheterization is an easily learned technique for internal jugular vein insertion, with significant improvements in overall success in those patients in whom a difficult vein access can be anticipated.
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