心血管疾患と診断

Comparison between Ultrasound-Guided and Anatomic Landmark Puncture of the Right Internal Jugular Vein

Abstract

Marcello Fonseca Salgado Filho, Phillip Lawall, Kleber Marcharet de Souza, Izabela Palitot, Izabela Magalhaes and Henrique Vasconcelos

Introduction: Central venous puncture guided by Ultrasound (US) is considered the technique of choice by the Society of Cardiovascular Anesthesiologists (SCA), and performing central venous puncture without employing US is considered poor medical practice.

Methods: After approval by the Research Ethics Committee of the National Institute of Cardiology a randomized clinical trial was conducted electronically with 40 patients (of both genders) who were between 45 and 65 years old and were scheduled to undergo Coronary Artery Bypass Surgery (CABG). The patients were electronically randomized (GraphPad 5.0 OS for Macintosh) divided into two groups of 20: the Ultrasound Group (USG) and the Blind Group (BG). The BG subjects were punctured according to anatomical definitions, and the USG subjects were punctured with US guidance.

Results: There were no differences in the demographic data. The duration of the puncture procedure was equal for the two groups (USG=130.7 ± 57.1 sec and BG=149.4 ± 98.1 sec; p=0.78). The incidence of carotid puncture was the same for the two groups (USG=0 (0%) and BG=2 (8.5%); p=0.48). The USG had a lower incidence of changing the puncture site (USG=0 (0%) and BG=4 (23%); p=0.03) and a higher incidence of catheter implantation in a single attempt (USG=16 (100%) and BG=10 (58%).

Conclusions: The use of US for insertion of central venous catheters is associated with a higher incidence of performing venous puncture in a single attempt, a lower incidence of vascular complications and a lower incidence of changing the puncture site.