Ultrasound-Guided Central Venous Cannulation in Bariatric Patients
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RESEARCH ARTICLE
Ultrasound-Guided Central Venous Cannulation in Bariatric Patients Claudia Brusasco & Francesco Corradi & Pier Luigi Zattoni & Claudio Launo & Yigal Leykin & Salvatore Palermo
Received: 11 February 2009 / Accepted: 2 June 2009 / Published online: 25 June 2009 # Springer Science + Business Media, LLC 2009
Abstract Background Central venous catheterization may be difficult in morbidly obese patients because anatomic landmarks are often obscured. Methods We evaluated the efficacy and safety of ultrasoundguided central venous cannulation in 55 patients undergoing bariatric surgery. The usefulness of ultrasonic examination combined with intraatrial electrocardiogram as a diagnostic tool for catheter misplacement was studied. Results Preliminary ultrasound examination of the neck vessels demonstrated anatomical variations in the position of internal jugular vein in 19 cases and four unrecognized asymptomatic thromboses of the right internal jugular vein. Central venous catheterization was successful in all 55 patients, in 51 with single skin puncture, and in 42 with single vein puncture. In three cases in whom the catheter was misplaced, this was detected by bedside ultrasonic examination during the procedure and immediately corrected by real-time echographic visualization. No arterial puncture, no hematoma, and no pneumothorax occurred in any patient. Successful catheter placement was also
Financial support None. Conflict of interest None. C. Brusasco (*) : F. Corradi : P. L. Zattoni : C. Launo : S. Palermo Section of Anesthesia and Intensive Care Medicine—DICMI, University of Genoa, Largo Rosanna Benzi 2, 16132 Genoa, Italy e-mail: [email protected] Y. Leykin Anesthesia and Intensive Care Medicine, Santa Maria degli Angeli Medical Centre, Pordenone, Italy
confirmed in all patients by post-operative chest X-ray. No evidence of infection or thrombosis subsequently was noted. Conclusions The use of ultrasound guidance may increase the success rate and decrease the incidence of complications associated with central venous cannulation. The advantages of this approach is visualization of the anatomical structures at puncture site prior to skin puncture and the ability to track needle and guide-wire placement during the procedure. With its high accuracy in detecting catheter misplacement, bedside ultrasonic examination combined with intraatrial electrocardiogram may further decrease morbidity associated with misplaced central venous catheters. Keywords Morbidly obese patients . Central venous catheterization . Ultrasound . Intraatrial electrocardiogram
Introduction Central venous catheters are generally used during surgery to allow measurements of hemodynamic variables, for delivery of medications, and for nutritional support. Ultrasound guidance has been recommended [1] to increase the success of catheter positioning and decrease the incidence of complications [2, 3], but it is not always routinely used [4]. In bariatric surgery, a central venous catheter may be necessary if there is difficu
