Ultrasound-Based SECURED Protocol for Central Venous Catheterization: A Feasibility Study.

Area of Science:

• Emergency Medicine
• Critical Care
• Point-of-Care Ultrasound (POCUS)

Background:

• Central venous catheterization (CVC) is vital for critically ill patients but carries risks of mechanical complications.
• Current ultrasound-guided (USG) CVC practices are often fragmented, limiting their full potential.
• The SECURED protocol was developed to integrate POCUS into a standardized, six-step CVC workflow.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of the SECURED protocol for central venous catheterization.
• To assess the protocol's completion rate and its impact on complication detection.
• To compare the time efficiency of ultrasound-based complication detection with traditional chest radiography.

Main Methods:

• A prospective observational study involving 109 adult patients undergoing internal jugular vein (IJV) CVC in the emergency department (ED).
• The SECURED protocol includes pre- and post-procedure ultrasound scans of the IJV, pleura, and heart.
• Primary endpoint: protocol completion rate. Secondary endpoint: time for complication detection via ultrasound vs. chest radiography.

Main Results:

• The SECURED protocol demonstrated a 100% completion rate in all 109 cases.
• The protocol identified pre-existing IJV thrombosis, prevented arterial punctures, and detected venous dissection.
• Ultrasound-based detection of pneumothorax and catheter malposition was significantly faster (2.5 min) than chest radiography (12.4 min).

Conclusions:

• The SECURED protocol offers a practical, time-efficient screening framework for CVC.
• It standardizes POCUS use, enabling proactive risk detection and immediate post-procedural confirmation.
• Further validation in larger studies may support broader implementation for improved clinical decision-making.