Comparative analysis of mechanical complications of emergency versus planned ultrasound-guided internal jugular venous (IJV) cannulation: data from the emergency room of a third-level hospital in Quito, Ecuador

Augusto Maldonado,Pablo Endara,Jorge Estrella Porter,Luis Vidal

doi:10.12688/f1000research.23849.1

Augusto Maldonado, Pablo Endara + Show 2 more

Open Access

https://doi.org/10.12688/f1000research.23849.1

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Abstract

Background: Central venous catheters (CVC’s) are useful tools for the treatment of critically ill patients, especially in the emergency room, and are recognized for decreasing rates of failure and mechanical complications. Certain parameters can act as predictors to determine the likelihood of this type of complication. The aim of this study is to determine the incidence and predictors of mechanical complications using internal jugular venous (IJV) cannulation, especially when considering planned versus emergency cannulation. Methods: A prospective, observational study was performed at Hospital de los Valles, Quito, Ecuador, during a three-year period. All patients who presented to the emergency room with an indication for IJV cannulation and with no potential contraindications were included. Demographic, safety and procedure related data were collected. Variables were analyzed using STATA, and p-values <0.05 were considered significant. Results: A total of 142 patients were included. The majority of procedures (64%) were planned. The main indication for CVC placement via IJV cannulation was chronic renal failure (54%), all of which were planned procedures, followed by sepsis (15%), where most procedures (91%) were emergencies. The IJV was anatomically located lateral to the carotid artery in 38.73% of cases. Mechanical/technical complications were reported in 13 patients. Cannulation time greater than two minutes was found to be the only factor independently associated with a higher probability (12.4 times) of developing mechanical/technical complications. The vessel location did not affect the incidence of complications either in emergency or planned procedures when using ultrasound. Conclusions: Ultrasound-guided IJV cannulation is a safe technique that can be performed as an emergency or planned procedure without increased complication rates in the emergency room. Additionally, a puncture time of less than two minutes is associated with the safest profile in this patient population.

Highlights

Central venous catheters (CVC’s) are a very useful tool for the treatment of critically ill patients[1]
It was demonstrated that clinicians can confidently perform a CVC insertion with ultrasound, either in emergency or planned situations, since there is no significant difference in the development of complications
Training in vascular access with ultrasound guidance has an enormous impact in patient safety and in the reduction of complications related to CVC

Summary

Introduction

Central venous catheters (CVC’s) are a very useful tool for the treatment of critically ill patients[1]. The use of ultrasound-guided techniques for vein cannulation has helped to reduce the rate of complications[4], and its use has been standardized in many emergency rooms around the world[5]. Central venous catheters (CVC’s) are useful tools for the treatment of critically ill patients, especially in the emergency room, and are recognized for decreasing rates of failure and mechanical complications. The aim of this study is to determine the incidence and predictors of mechanical complications using internal jugular venous (IJV) cannulation, especially when considering planned versus emergency cannulation. All patients who presented to the emergency room with an indication for IJV cannulation and with no potential contraindications were included.

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