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REDAR-544; No. of Pages 2
Rev Esp Anestesiol Reanim. 2014;xxx(xx):xxx---xxx
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Real-time ultrasound detection of correct intravenous placement of central venous catheters after ultrasound cannulation Comprobación ecográfica en tiempo real de la colocación intravenosa de catéteres venosos centrales tras canulación ecoguiada J.M. Bele˜ na a,∗ , D. Anta a , E. Barrio a , M. Nu˜ nez b a b
Servicio de Anestesiología y Reanimación, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain Servicio de Anestesiología y Reanimación, Hospital Universitario Ramón y Cajal, Madrid, Spain
Ultrasound-guided technique for central venous catheterization has been a widely developed procedure during the last decade. Nowadays, it is a common technique in the anaesthesiologist’s clinical practice. During the last six years, we usually have carried out central venous catheterization using the ultrasound-guided technique in our hospital. Moreover, we use to check correct intravenous placement of the catheter by using the ‘‘real-time’’ or ‘‘dynamic’’ ultrasound technique. We think this is an important part of the procedure sometimes forgotten by the anaesthetist. This simple manoeuvre has some benefits: to verify the intravenous placement of the catheter, to confirm if the catheter remains fixed to the vessel wall and also to check the potential injure and haematoma caused to the vein. This manoeuvre does not require change in the position of the probe used for cannulation, the catheter can be verified when both, long or short axis, approaches are employed. If superficial vein cannulation is performed (femoral, internal jugular), an ‘‘out of plane’’ approach using the short
∗
Corresponding author. E-mail address: [email protected] (J.M. Bele˜ na).
Figure 1 Long axis view of the subclavian vein and surrounding structures in the right infraclavicular fossa. Triple lumen catheter is shown, differentiating between the 3 separate lumen (arrow heads). SV, subclavian vein; SCT, subcutaneous cellular tissue; PM, pectoralis major; pm, pectoralis minor.
http://dx.doi.org/10.1016/j.redar.2014.11.002 0034-9356/© 2014 Sociedad Espa˜ nola de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España, S.L.U. All rights reserved.
Please cite this article in press as: Bele˜ na JM, et al. Real-time ultrasound detection of correct intravenous placement of central venous catheters after ultrasound cannulation. Rev Esp Anestesiol Reanim. 2014. http://dx.doi.org/10.1016/j.redar.2014.11.002
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ARTICLE IN PRESS
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J.M. Bele˜ na et al.
Figure 2 Short axis view of the femoral vein and surrounding structures in the right groin. Triple lumen catheter is shown, differentiating between the 3 separate lumen (arrow). FV, femoral vein; FA, femoral artery; SCT, subcutaneous cellular tissue; IL, inguinal ligament.
axis is recommended (Figs. 2---3), although long axis position of the probe is also useful for intravenous placement of the catheter. In case of deeper vein catheterization (subclavia, axillary), ‘‘in plane’’ approach using the long axis is more commonly suggested (Fig. 1) and the short axis position of the probe has poor results in order to confirm the catheter’s position. In addition, ‘‘real-time’’ ultrasound correct catheter placement confirmation technique is recommended by the main international guidelines of ultrasound vascular access. These guidelines propose this manoeuvre to ensure
Figure 3 Short axis view of the internal jugular vein and surrounding structures in the right anterior neck. Triple lumen catheter is shown, differentiating between the 3 separate lumen (arrow). IJV, internal jugular vein; CA, carotid artery; SCM, sternocleidomastoid; SA, scalenus anterior.
appropriate placement of the catheter and to assess for possible complications. We conclude that real-time ultrasound detection of correct intravenous placement of central venous catheters after ultrasound cannulation is a simple, effective and recommended method to verify the success of the ultrasound-guided technique, as well as a good practice to assess for potential complications.
Please cite this article in press as: Bele˜ na JM, et al. Real-time ultrasound detection of correct intravenous placement of central venous catheters after ultrasound cannulation. Rev Esp Anestesiol Reanim. 2014. http://dx.doi.org/10.1016/j.redar.2014.11.002
ARTICLE IN PRESS
REDAR-544; No. of Pages 2
Rev Esp Anestesiol Reanim. 2014;xxx(xx):xxx---xxx
Revista Española de Anestesiología y Reanimación www.elsevier.es/redar
IMAGES OF THE MONTH
Real-time ultrasound detection of correct intravenous placement of central venous catheters after ultrasound cannulation Comprobación ecográfica en tiempo real de la colocación intravenosa de catéteres venosos centrales tras canulación ecoguiada J.M. Bele˜ na a,∗ , D. Anta a , E. Barrio a , M. Nu˜ nez b a b
Servicio de Anestesiología y Reanimación, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain Servicio de Anestesiología y Reanimación, Hospital Universitario Ramón y Cajal, Madrid, Spain
Ultrasound-guided technique for central venous catheterization has been a widely developed procedure during the last decade. Nowadays, it is a common technique in the anaesthesiologist’s clinical practice. During the last six years, we usually have carried out central venous catheterization using the ultrasound-guided technique in our hospital. Moreover, we use to check correct intravenous placement of the catheter by using the ‘‘real-time’’ or ‘‘dynamic’’ ultrasound technique. We think this is an important part of the procedure sometimes forgotten by the anaesthetist. This simple manoeuvre has some benefits: to verify the intravenous placement of the catheter, to confirm if the catheter remains fixed to the vessel wall and also to check the potential injure and haematoma caused to the vein. This manoeuvre does not require change in the position of the probe used for cannulation, the catheter can be verified when both, long or short axis, approaches are employed. If superficial vein cannulation is performed (femoral, internal jugular), an ‘‘out of plane’’ approach using the short
∗
Corresponding author. E-mail address: [email protected] (J.M. Bele˜ na).
Figure 1 Long axis view of the subclavian vein and surrounding structures in the right infraclavicular fossa. Triple lumen catheter is shown, differentiating between the 3 separate lumen (arrow heads). SV, subclavian vein; SCT, subcutaneous cellular tissue; PM, pectoralis major; pm, pectoralis minor.
http://dx.doi.org/10.1016/j.redar.2014.11.002 0034-9356/© 2014 Sociedad Espa˜ nola de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España, S.L.U. All rights reserved.
Please cite this article in press as: Bele˜ na JM, et al. Real-time ultrasound detection of correct intravenous placement of central venous catheters after ultrasound cannulation. Rev Esp Anestesiol Reanim. 2014. http://dx.doi.org/10.1016/j.redar.2014.11.002
+Model REDAR-544; No. of Pages 2
ARTICLE IN PRESS
2
J.M. Bele˜ na et al.
Figure 2 Short axis view of the femoral vein and surrounding structures in the right groin. Triple lumen catheter is shown, differentiating between the 3 separate lumen (arrow). FV, femoral vein; FA, femoral artery; SCT, subcutaneous cellular tissue; IL, inguinal ligament.
axis is recommended (Figs. 2---3), although long axis position of the probe is also useful for intravenous placement of the catheter. In case of deeper vein catheterization (subclavia, axillary), ‘‘in plane’’ approach using the long axis is more commonly suggested (Fig. 1) and the short axis position of the probe has poor results in order to confirm the catheter’s position. In addition, ‘‘real-time’’ ultrasound correct catheter placement confirmation technique is recommended by the main international guidelines of ultrasound vascular access. These guidelines propose this manoeuvre to ensure
Figure 3 Short axis view of the internal jugular vein and surrounding structures in the right anterior neck. Triple lumen catheter is shown, differentiating between the 3 separate lumen (arrow). IJV, internal jugular vein; CA, carotid artery; SCM, sternocleidomastoid; SA, scalenus anterior.
appropriate placement of the catheter and to assess for possible complications. We conclude that real-time ultrasound detection of correct intravenous placement of central venous catheters after ultrasound cannulation is a simple, effective and recommended method to verify the success of the ultrasound-guided technique, as well as a good practice to assess for potential complications.
Please cite this article in press as: Bele˜ na JM, et al. Real-time ultrasound detection of correct intravenous placement of central venous catheters after ultrasound cannulation. Rev Esp Anestesiol Reanim. 2014. http://dx.doi.org/10.1016/j.redar.2014.11.002
