Prospective evaluation of ultrasound-guided short catheter placement in internal jugular veins of difficult venous access patients

Abstract

RationaleDifficult vascular access (DVA) is a common problem. Placement of ultrasound-guided standard length catheters (ultrasound-guided peripheral intravenous [USPIV]) in the internal jugular (IJ) vein is a potential solution. ObjectivesThe objective of the study is to evaluate the immediate and short-term incidence of complications after USPIV placement in IJ of DVA patients. MethodsWe conducted a prospective convenience study of USPIV into IJ of emergency department patients with DVA. All USPIV placements were performed with standard aseptic techniques with either an 18-gauge 6.35-cm single-lumen catheter or 20-gauge 5.7-cm catheter.Immediate complications were evaluated. Clinical follow-up consisted of review of the electronic medical record for physician and nursing documentation, laboratory data, and imaging studies in a multiple hospital network. Outcome measures 1 and 6 weeks included local site abnormalities, bleeding, local or systemic infection, pneumothorax, or thrombosis at time of placement, and death. ResultsWe enrolled 33 patients (58% female; mean age, 56.4 years; and median body mass index of 24.7). Eleven physicians performed USPIV placement. Median access time was 4.0 (interquartile range, 5.5) minutes and 1 attempt for placements. There were no immediate complications. Follow-up was successful in 5 of 7 discharged patients and 26 of 27 admitted patients. Three deaths within 6 weeks were unrelated to USPIV. Three patients lost to follow-up were not discovered on electronic medical record or death registries. No patient had catheter-related complications. ConclusionsThere were no immediate or short-term complications associated with aseptic USPIV placement into IJ. Ultrasound-guided peripheral intravenous IJ placement was a rapid and safe approach in DVA patients.