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Evaluation of Success Rate of Ultrasound-Guided Venous Cannulation in Patients with Difficult Venous Access
S Etezazizn,B Tavakoli,A Hekmatnia,N Omidifar
Iranian Journal of Radiology , 2010,
Abstract: "nBackground/Objective: We evaluated a new ultrasound-guided approach to percutaneous cephalic vein or basilic vein cannulation in patients with difficult intravenous access. "nPatients and Methods: Patients who required intravenous access and were candidates for surgical approach, or central venous catheterization were enrolled into the study. They had at least three unsuccessful attempts at establishing a peripheral intravenous line. By using a 7.5-MHz ultrasound probe, the cephalic or basilic vein was identified and then cannulated with a conventional venous cannula. The time from probe placement to cannulation, the number of attempts and complications were recorded. "nResults: Eighty-eight patients were enrolled; 28 (31.8%) female and 60 (68.2%) male. The intravenous (IV) drug abusers consisted of 29 patients (33%) which were all men (48% of males). The procedure was successful in 94.3% and failed in five cases (5.7%) after three attempts. The mean time of procedure was 175±153 seconds. There was a significant difference between IV drug abusers (231±203) and non IV drug abusers (149±118) regarding access time (p-value=0.012). The procedure was successful after one attempt in 61 patients (73.5%), two attempts in 20 patients (24.1%) and three attempts in two patients (2.4%). The cannula was dislodged in three cases after one hour of follow-up. No other complications happened. Conclusion: Ultrasound-guided cephalic and basilic vein cannulation is safe and time saving, has a high success rate in patients with difficult peripheral intravenous access, and may be used as the first step in these patients before the other more invasive alternatives.
Brachial plexus palsy due to subclavian artery pseudo aneurysm from internal jugular cannulation
Modi Manisha,Shah Veena
Indian Journal of Critical Care Medicine , 2007,
Abstract: Internal jugular vein is the preferred route for central venous cannulation because of easy accessibility and high success rate. Arterial puncture is the most common complication, the reported incidence being 9.3%. However, brachial plexus palsy following arterial puncture is a rare complication of this procedure. We report a case of brachial plexus palsy due to compression by right subclavian pseudoaneurysm as a result of internal jugular vein cannulation in chronic renal failure patient.
Ultrasound-Guided Infraclavicular Axillary Vein Cannulation  [PDF]
Miguel A. García-Díaz, Manuel Ruiz-Castro
International Journal of Clinical Medicine (IJCM) , 2017, DOI: 10.4236/ijcm.2017.84022
Abstract: Background and Objective: Percutaneous central venous cannulation is a common invasive procedure. In comparison with an external landmark technique, the advantages of ultrasound-guided venous access include direct visualization of the anatomy and in vivo visualization of venous cannulation. Methods: We evaluated an ultrasound-guided technique for infraclavicular axillary vein cannulation, focusing on its ease of use, success rate and complications rate. One hundred and twenty patients who submitted to central venous catheter placement were punctured using our technique. The patients were positioned so that their ipsilateral upper limb was abducted at 90° to the longitudinal axis, which makes it possible to visualize the infraclavicular vessels due to the elevation of the clavicle, thereby improving accessibility. Results: Cannulation was successful in all patients. The median time from the start of the first puncture (of the skin) until the aspiration of blood was 15 s (range 7 - 135 s). Both infraclavicular axillary veins were cannulated, and the vein was punctured successfully at the first attempt in 95% of the patients, without complications during the procedure. Conclusion: We propose an ultrasound-guided infraclavicular approach of the axillary vein, with a high success rate and no complications in the present cohort.
Portal vein cannulation: An uncommon complication of endoscopic retrograde cholangiopancreatography  [cached]
Evangelos Kalaitzakis,Nicholas Stern,Richard Sturgess
World Journal of Gastroenterology , 2011, DOI: 10.3748/wjg.v17.i46.5131
Abstract: Portal vein cannulation is a rare complication of endoscopic retrograde cholangiopancreatography (ERCP). It has been reported that it usually occurs after endoscopic sphincterotomy, whereas in cases without prior sphincterotomy, the presence of portobiliary fistulas has been shown. Here, we present a case in which cannulation of the portal vein occurred despite careful wire-guided cannulation and the absence of sphincterotomy. Although fatal cases of cerebral and pulmonary air and/or bile embolism have been reported in patients with combined portal and hepatic vein trauma after ERCP and sphincterotomy, isolated portal vein cannulation, as in the current case, does not usually result in mortality or serious morbidity. However, awareness of this rare complication is important so that no further intervention is performed.
Can we make the basilic vein larger? maneuvers to facilitate ultrasound guided peripheral intravenous access: a prospective cross-sectional study
Simon A Mahler, Greta Massey, Liliana Meskill, Hao Wang, Thomas C Arnold
International Journal of Emergency Medicine , 2011, DOI: 10.1186/1865-1380-4-53
Abstract: This was a prospective non-randomized trial. Healthy volunteers aged 18-65 were enrolled. Basilic veins were identified and the cross-sectional area measured sonographically. Following baseline measurement, the following maneuvers were performed: application of a tourniquet, inflation of a blood pressure (BP) cuff, application of a tourniquet with the arm lowered, and BP cuff inflation with the arm lowered. Following each maneuver there was 30 s of recovery time, and a baseline measurement was repeated to ensure that the vein had returned to baseline. Change in basilic vein size was modeled using mixed model analysis with a Tukey correction for multiple comparisons to determine if significant differences existed between different maneuvers.Over the 5-month study period, 96 basilic veins were assessed from 52 volunteers. All of the maneuvers resulted in a statistically significant increase in basilic vein size from baseline (p < 0.001). BP cuff inflation had the greatest increase in vein size from baseline 17%, 0.87 mm 95% CI (0.70-1.04). BP cuff inflation statistically significantly increased vein size compared to tourniquet placement by 3%, 0.16 mm 95% CI (0.02-0.30).The largest increase in basilic vein size was due to blood pressure cuff inflation. BP cuff inflation resulted in a statistically significant increase in vein size compared to tourniquet application, but this difference may not be clinically significant.Intravenous (IV) access is often required in Emergency Department (ED) patients. Landmark techniques for obtaining peripheral IV access are usually successful, but patients with prior IV drug abuse, obesity, and chronic medical conditions are more likely to have failed attempts [1,2]. Several studies have demonstrated that ultrasound can be used to successfully place peripheral IVs in patients who have failed landmark techniques [1,3-6]. Prior to ultrasound-guided peripheral intravenous access (USGPIV), patients with failed landmark techniques often req
Comparison of ultrasound-guided vs. anatomical landmark-guided cannulation of the femoral vein at the optimum position in infant
AA Eldabaa, AAA Elhafz
Southern African Journal of Anaesthesia and Analgesia , 2012,
Abstract: Background: Femoral vein cannulation can be a routine process during major surgery in infants and children, and may prove to be lifesaving under certain conditions. This study compared ultrasound (US)-guided cannulation of the femoral vein in infants with the traditional anatomical landmark-guided technique. Method: Eighty infants who had been prepared for major elective surgery under general anaesthesia were randomly assigned either to Group I, in which the femoral vein cannulation was guided by anatomical landmarks in optimally positioned patients, or to Group II in which the US-guided technique was used for cannulation. Results: The procedure was successful in 35 cases in Group I, and in all cases in Group II. The number of needle passes was higher in Group I, compared to Group II [4 (1-22) vs. 1 (1-8); p-value = 0.001]. First-pass success was achieved in 20 cases in Group I, and in 35 cases in Group II. The time to complete cannulation was significantly shorter in Group II, compared to Group I [145 (40-650) vs. 350 (40-1 600) seconds; p-value = 0.02]. Three cases of arterial puncture occurred in Group I, while there were no complications in Group II. Conclusion: The US-guided technique for femoral vein cannulation is useful as it results in greater success, shorter cannulation times, fewer attempts, and fewer complications.
Internal jugular vein cannulation: an ultrasound-guided technique versus a landmark-guided technique
Turker, Gurkan;Kaya, Fatma Nur;Gurbet, Alp;Aksu, Hale;Erdogan, Cuneyt;Atlas, Ahmet;
Clinics , 2009, DOI: 10.1590/S1807-59322009001000009
Abstract: objectives: to compare the landmark-guided technique versus the ultrasound-guided technique for internal jugular vein cannulation in spontaneously breathing patients. methods: a total of 380 patients who required internal jugular vein cannulation were randomly assigned to receive internal jugular vein cannulation using either the landmark- or ultrasound-guided technique in bursa, uludag university faculty of medicine, between april and november, 2008. failed catheter placement, risk of complications from placement, risk of failure on first attempt at placement, number of attempts until successful catheterization, time to successful catheterization and the demographics of each patient were recorded. results: the overall complication rate was higher in the landmark group than in the ultrasound-guided group (p < 0.01). carotid puncture rate and hematoma were more frequent in the landmark group than in the ultrasound-guided group (p < 0.05). the number of attempts for successful placement was significantly higher in the landmark group than in the ultrasound-guided group, which was accompanied by a significantly increased access time observed in the landmark group (p < 0.05 and p < 0.01, respectively). although there were a higher number of attempts, longer access time, and a more frequent complication rate in the landmark group, the success rate was found to be comparable between the two groups. conclusion: the findings of this study indicate that internal jugular vein catheterization guided by real-time ultrasound results in a lower access time and a lower rate of immediate complications.
Anatomical variations of the clavicle and main vascular structures in two pediatric patients: subclavicular vein cannulation with supraclavicular approach
Oksuz H,Senoglu N,Yildiz H,Demirkiran H
International Journal of Anatomical Variations , 2009,
Abstract: Central venous catheterization is a routine application in the management of patients in critical condition. However, the placement of central venous catheters is not without risk. The standard technique for central venous cannulation includes the use of anatomical landmarks. However, an ultrasound-guided method is recommended for catheterization in high-risk patients. In this report, we present two pediatric cases which had anatomical variations of the clavicles and main vascular structures due to cerebral palsy and were treated with mechanical ventilation because of pneumonia. The subclavian vein cannulation was performed using a supraclavicular approach under ultrasound guidance in both cases. We conclude that central venous catheterization of critical patients who have anatomical variations must be performed under ultrasound guidance as it provides greater safety and a higher success rate.
A New Biplane Ultrasound Probe for Real-Time Visualization and Cannulation of the Internal Jugular Vein  [PDF]
Jeremy Kaplowitz,Paul Bigeleisen
Case Reports in Anesthesiology , 2014, DOI: 10.1155/2014/349797
Abstract: Ultrasound guidance is recommended for cannulation of the internal jugular vein. Use of ultrasound allows you to identify relevant anatomy and possible anatomical anomalies. The most common approach is performed while visualizing the vein transversely and inserting the needle out of plane to the probe. With this approach needle tip visualization may be difficult. We report the use of a new biplane ultrasound probe which allows the user to simultaneously view the internal jugular vein in transverse and longitudinal views in real time. Use of this probe enhances needle visualization during venous cannulation. 1. Introduction Ultrasound (US) guidance is recommended for cannulation of the internal jugular vein (IJ) [1–3]. A recent meta-analysis found that US guided central venous access may lead to decreased risks of hematoma, arterial puncture, or pneumothorax [4]. Use of US in real time allows you to identify the relevant anatomy and any possible anatomical anomalies and visualize the path of your needle. US guided central venous access is primarily performed while visualizing the vein transversely and inserting the needle out of plane to the US probe. One major limitation of this approach is that visualization of the needle tip can be difficult. Failure to visualize your needle tip can lead to inadvertent arterial puncture or pneumothorax. We report the use of a new dual plane 4–10 megahertz US probe (BK 8824, BK Medical USA; Peabody, MA) which allows the user to simultaneously view the carotid artery (CA) and IJ in transverse and longitudinal views in real time (Figure 1). This provides the user with the familiar transverse view while being able to more clearly visualize your needle in the longitudinal view. Figure 1: A pictorial depiction of the BK 8824 US probe showing the configuration of the transverse and longitudinal transducers. T: transverse transducers; L: longitudinal transducer. 2. Case Presentation After positive initial experiences using this probe with a phantom (Blue Phantom, CAE Healthcare Sarasota, FL; Figure 2), we were able to cannulate the right IJ in a patient requiring central venous cannulation for surgery. Figure 2: Images from our use in a Blue Phantom training phantom with an 18 gauge 40 millimeter VascularSono cannula (Pajunk USA, Norcross, GA). This is the ideal view that can be obtained with this probe. You can clearly see the needle entering the simulated vein in both views, and the tip is clearly in the lumen in the longitudinal view. V: simulated vein. A 60-year-old, 78?kg, female with a past medical history significant
Finding on a chest radiograph: A dangerous complication of subclavian vein cannulation
Srinivasan Nataraj,Kumar Akshay
Indian Journal of Critical Care Medicine , 2010,
Abstract: Cannulation of the subclavian vein has its inherent risks. Post procedure chest radiograph is one of the investigations done to rule out immediate complications. Unless the clinician is aware as to what to look for in the radiograph, some of the dangerous complications can be overlooked. Accidental subclavian artery cannulation is identified immediately by color and jet of the blood. Also the position of the catheter tip has to be confirmed by obtaining the arterial pressure tracing using a pressure transducer. Non availability of Doppler ultrasound and pressure transducer are limiting factors for immediate confirmation of proper catheter placement. Also, in patients with severe hypotension and reduced oxygen content of blood, accidental arterial puncture may not show the characteristic bright red pulsatile back flow of arterial blood. In these situations radiography can be used as a diagnostic tool to rule out subclavian artery cannulation.
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