Efficacy and safety of ultrasound-guided central venous access in oncological and haematological patients: Results of a monocenter series of 519 consecutive patients

Abstract

8152 Background: The management of the cancer patients frequently relies on the ability to deliver a variety of intravenous agents over a prolonged period. A central venous catheter (CVC) currently represents the most frequently adopted intravenous line for patients undergoing infusional chemotherapy and/or high-dose chemotherapy with concomitant blood stem cell transplantation and parenteral nutrition. The aim of this study was to explore the feasibility and safety of CVC insertion under ultrasound (US) control. US offers the advantage of real-time, multiplanar imaging as well as Doppler analysis, which makes it very practical and improves safety by allowing the operator to identify major vessels. Methods: The patient is placed in Trendelenburg’s position. After sterilization, local anaesthesia is applied and a 7.5 MHz puncturing US probe is placed in the right supraclavicular site and a 16 gauge needle is advanced into the last portion of internal jugular vein nearly innominate vein under US-control; after insertion of the guidewire the catheter (Secalon Seldy, Becton Dickinson) is advanced into the superior vena cava until insertion to right atrium. At the end of the procedure an upright chest X-ray is carried out to confirm CVC position and to rule out a pneumothorax. Results: From June 2001 to June 2004 this procedure has been performed 600 times in 519 consecutive patients: 350 with solid tumors and 169 with hematological malignancies. Some patients underwent CVC insertion more then one time along their clinical course (complete remission, relapse, stem cell collection and transplantation, parenteral nutrition). The procedure was successful in 595/600 times (99.1%), mean time of CVC permanence was 151 days (range 7–701 days). Four cases of deep vein thrombosis were detected successfully treated with low molecular weight heparin. Infections episodes were 1.7/1000 days of use, successfully treated with antibiotics. No increase of infections was registered in the transplantation setting. No pneumothorax occurred. Conclusions: This procedure is safe, cheap with high accuracy and success rate, and above all US-guidance avoids pneumothorax. No significant financial relationships to disclose.