Ultrasound-guided cannulation of central veins in critically ill patients – point-of-care ultrasound approach

Introduction: Cannulation of central veins in critically ill patients is usually done blind using the well known anatomic landmark technique. Patient's position is dorsal decubitus or Trendelenburg. Patients having intracerebral hypertension need central veins cannulation by standing in dorsal decubitus with thorax raised at 250.

In certain patients, placement of central venous catheter could have a high risk for catheter-related complications (carotid artery damage, air embolia). These complications could be easily avoided by using ultrasound guided cannulation in real time by patient's bed.

Objective: Safety estimation and protocol design for creating a „point-of-care ultrasound“ in intensive care unit.

Method: We studied 112 patients that needed central venous access. Patients without risk factors were cannulated classically – control group (56 patients). Patients having risk factors for difficult cannulation (no detectable pulse to carotid artery, obesity, generalized edema, short neck, patients in dorsal decubitus with thorax raised) were cannulated by using a real time protocol of ultrasound guided cannulation of central veins – study group (56 patients).

Results: The cannulation of central veins in critically patients was successfully done in all patients without complications.

Conclusions: Ultrasound guided cannulation of central veins is a fast and safe procedure and could be done near the patient bed. It is the technique to choose in patients with risk factors for classical cannulation.