Optimization of Cannula Visibility during Ultrasound-Guided Subclavian Vein Catheterization via a Longitudinal Approach by Implementing Echogenic Technology
Stefanidis K, Fragou M, Pentilas N, Kouraklis G, Nanas S, Savel RH, Shiloh AL, Slama M, Karakitsos D - Crit Care Res Pract (2012)
Bottom Line：
Access time (12.1 s ± 6.5 versus 18.9 s ± 10.9) and the perceived technical difficulty of the ultrasound method (4.5 ± 1.5 versus 7.5 ± 1.5) were both decreased in the EC group compared to the NEC group (P < 0.05).
Conclusions：Echogenic technology significantly improved cannula visibility and decreased access time and technical complexity optimizing thus real-time ultrasound-guided SCV cannulation via a longitudinal approach.
Affiliation：Radiology Department, Evangelismos University Hospital, 10676 Athens, Greece.
（http://www.hindawi.com/journals/ccrp/2012/617149/）
ABSTRACT
Objective.
One limitation of ultrasound-guided vascular access is the technical challenge of visualizing the cannula during insertion into the vessel. We hypothesized that the use of an echogenic vascular cannula (EC) would improve visualization when compared with a nonechogenic vascular cannula (NEC) during real-time ultrasound-guided subclavian vein (SCV) cannulation in the ICU. Material and Methods. Eighty mechanically ventilated patients were prospectively enrolled in a randomized study that was conducted in a medical-surgical ICU. Forty patients underwent EC and 40 patients were randomized to NEC. The procedure was ultrasound-guided SCV cannulation via the infraclavicular approach on the longitudinal axis.
Results.
The EC group exhibited increased cannula visibility as compared to the NEC group (92%±3% versus 85 ± 7%, resp., P < 0.01). There was strong agreement between the procedure operators and independent observers (k = 0.9, 95% confidence intervals assessed by bootstrap analysis = 0.87 to 0.93; P < 0.01). Access time (12.1 s ± 6.5 versus 18.9 s ± 10.9) and the perceived technical difficulty of the ultrasound method (4.5 ± 1.5 versus 7.5 ± 1.5) were both decreased in the EC group compared to the NEC group (P < 0.05).
Conclusions.
Echogenic technology significantly improved cannula visibility and decreased access time and technical complexity optimizing thus real-time ultrasound-guided SCV cannulation via a longitudinal approach.
Fig2：Echogenic cannula entering the SCV just adjacent to the sternum (A B); the former incorporates “Cornerstone” reflectors mainly arranged at its distal 2 cm (C), which increase significantly its visibility (D).
Mentions：All patients were placed in Trendelenburg position and were cannulated as described in detail by Fragou et al. Triple-lumen catheters were used in all cases and all procedures were performed under controlled and nonemergent conditions in the ICU. Standard sterile precautions were utilized. The EC and NEC were both 18 gauge cannulas specifically intended for use in vascular access. Ultrasonography was performed with an HD11 XE ultrasound machine (Philips, Andover, MA, USA) equipped with a high-resolution 7.5–12 MHz transducer, which was covered with sterile ultrasonic gel and wrapped in a sterile sheath (Microtec medical intraoperative probe cover, 12 cm × 244 cm). Using the infraclavicular approach, on the longitudinal axis, sonoanatomic landmarks (such as the acoustic shadows of the underlying first thoracic rib and of the sternum) were identified, as well as, the axillary and SCV vein (Figures 1 and 2). Doppler techniques were utilized to confirm the two-dimensional (2D) findings. Vessels were cannulated using the Seldinger technique under real-time ultrasound guidance.
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