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. 2022 Sep 17;14(9):e29259.
doi: 10.7759/cureus.29259. eCollection 2022 Sep.

Point-of-Care Ultrasound Protocol for Insertion and Confirmation of Central Venous Catheter Placement

Pedro R Soares  1 , Andre Maia  2 , Jorge R Fernandes  3 , Diogo Faustino  4 , Ana Luísa Campos  5 , Luís R Almeida  3 , José Mariz  6
Affiliations

Point-of-Care Ultrasound Protocol for Insertion and Confirmation of Central Venous Catheter Placement

Pedro R Soares et al. Cureus. .

Abstract

Central venous catheterization is a common procedure in the management of critically ill patients, in the context of medical emergencies, and before surgical interventions. Placing a central venous catheter (CVC) in the internal jugular vein (IJV) using anatomical references is associated with a high risk of complications, in particular pneumothorax and arterial puncture. Thus, the placement of CVCs with ultrasound support is recommended by several medical societies and health regulators at the international level. When compared with chest radiography, ultrasound is accessible, safe, cost-effective, and time efficient. This technical report is meant to detail a point-of-care ultrasound protocol designed for the insertion and confirmation of the correct placement of a CVC in the IJV.

Keywords: central venous catheter; cvc confirmation; pocus; point-of-care ultrasound; ultrasound; vascular access.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Sonoanatomy of the IJV (*) and its topographical relationship with CA. On the right, the compressibility of the vein compared to the artery is demonstrated.
Sonoanatomy of the right IJV with the operator at the head of the bed and the indicator probe point directed to the patient's left side. IJV: internal jugular vein; CA: carotid artery.
Figure 2
Figure 2. Apical four-chamber (left) and subcostal four-chamber (right) windows in two-dimensional mode.
RA: right atrium; LA: left atrium; RV: right ventricle; LV: left ventricle.
Figure 3
Figure 3. Subcostal bicaval view visualization of a turbulent flow in the right atrium (RA), after the administration of 5 mL of a saline solution in the CVC.
CVC: central venous catheter; IVC: inferior vena cava; RASS: rapid atrial swirl sign.
Figure 4
Figure 4. Assessment of the left apex position using the lung ultrasound.
P: pleura; A: A lines; C: rib (and acoustic shadow).
Figure 5
Figure 5. The observation of the seashore sign using the M-mode can be useful to rule out procedure-related pneumothorax.
See this image and copyright information in PMC

References

    1. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. Merrer J, De Jonghe B, Golliot F, et al. JAMA. 2001;286:700–707. - PubMed
    1. Central vein catheterization. Failure and complication rates by three percutaneous approaches. Sznajder JI, Zveibil FR, Bitterman H, Weiner P, Bursztein S. https://pubmed.ncbi.nlm.nih.gov/3947185/ Arch Intern Med. 1986;146:259–261. - PubMed
    1. Recommendations on the use of ultrasound guidance for central and peripheral vascular access in adults: a position statement of the Society of Hospital Medicine. Franco-Sadud R, Schnobrich D, Mathews BK, et al. https://shmpublications.onlinelibrary.wiley.com/doi/epdf/10.12788/jhm.3287 J Hosp Med. 2019;14:0. - PMC - PubMed
    1. Soni NJ, Arntfield R, Kory P. Amsterdam, Netherlands: Elsevier; 2019. Point of Care Ultrasound; pp. 339–347.
    1. Effects of clinical maneuvers on sonographically determined internal jugular vein size during venous cannulation. Mallory DL, Shawker T, Evans RG, et al. Crit Care Med. 1990;18:1269–1273. - PubMed

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