Pre-procedure ultrasound increases the success and safety of central venous catheterization†

Br J Anaesth. 2014 Jul;113(1):122-9. doi: 10.1093/bja/aeu049. Epub 2014 Mar 18.


Background: Real-time ultrasound (US) in central venous catheterization is superior to pre-procedure US. However, moving real-time US into routine practice is impeded by its perceived expense and difficulty. Currently, pre-procedure US and landmark (LM) methods are most widely used. We investigated these techniques in internal jugular vein (IJV) catheterization in respect of operator experience, complications, and risk factors.

Methods: In an observational non-randomized study, we investigated 606 of ∼1300 procedures, that is, 200 patients were treated under pre-procedure US and 406 under LM [pathfinder (PF) n=202, direct cannulation (DC) n=204]. We recorded first needle pass success rate, success rate after the third attempt, and the cannulation time. Procedures were performed by inexperienced (<100) or experienced (>100 catheterizations) operators.

Results: Pre-procedure US was associated with more successful attempts and shorter cannulation times. Under pre-procedure US, 88% of first attempts were successful and 100% of third attempts. The median (range) cannulation time was 39 (10-330) s. Under PF, only 56% of first, and 87% of third, attempts were successful with a median (range) cannulation time of 100 (25-3600) s. Under DC, 61% of first and 89% of third attempts were successful; the median (range) cannulation time was 70 (10-3600) s. Remarkably, inexperienced operators using pre-procedure US (n=38) were significantly faster than experienced operators using PF or DC (n=343) (cannulation time: median 60 s, range 12-330, for inexperienced; 60 s, range 10-3600, for experienced). First puncture success rates were higher (pre-procedure US, inexperienced 84%, PF or DC, experienced 57%).

Conclusions: Pre-procedure US for IJV catheterization is safe, quick, and superior to LM.

Keywords: cannulation time; central venous catheterization; complications; internal jugular vein; success rate; ultrasound.

Publication types

  • Controlled Clinical Trial
  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anesthesia, General / methods
  • Catheterization, Central Venous / adverse effects
  • Catheterization, Central Venous / methods*
  • Clinical Competence
  • Female
  • Humans
  • Intraoperative Care / methods
  • Jugular Veins / diagnostic imaging*
  • Male
  • Middle Aged
  • Risk Factors
  • Time Factors
  • Treatment Failure
  • Ultrasonography, Interventional / methods
  • Young Adult