Ultrasound-guided central venous access.

HYPOTHESIS Real-time ultrasound guidance should increase the success rate and lower the complication rate of central venous access in patients with relative contraindications to having the procedure performed. DESIGN Prospective case series. SETTING A community-based tertiary care hospital. PATIENTS Fifty-two patients were studied. Relative risks to central venous catheter insertion included (1) thrombosis or stenosis of central veins, (2) inherent or acquired anticoagulation abnormalities, (3) inability to assume a supine position, (4) hypovolemia, (5) obesity or altered anatomy, and (6) severe respiratory compromise. INTERVENTIONS Real-time ultrasound evaluation of the proposed vein to be cannulated, followed by real-time percutaneous central vein access. MAIN OUTCOME MEASURES Successful cannulation of a central vein. RESULTS All attempts at central vein cannulation were successful. No bleeding complications occurred. One pneumothorax occurred in an obese patient. CONCLUSIONS Ultrasound-guided central venous access is a helpful technique to gain venous access in difficult cases. Surgeons who perform central venous access procedures should become acquainted with the techniques involved. The techniques should be incorporated into currently developing ultrasound instruction courses for surgeons.