A Point of Care Ultrasound During Catheterization of Internal Jugular Vein; Sonographic Assessment of the Venous Excavation (SAVE) Protocol

Jo, Min Su; Doh, Han Ho; Seo, Jun Seok; Lee, Sang Hun; Kim, Hee Young; Ha, Young Rock

Abstract

PURPOSE
Central venous catheterization (CVC) plays important roles in treatment of critically ill patients. Although use of ultrasound has led to a decrease in CVC related complications, adverse events still occur. Therefore, we usually check the chest x-ray for confirmation. The purpose of this study was to evaluate the usefulness of point of care ultrasound during catheterization of the internal jugular vein (IJV).
METHODS
The authors conducted a prospective study of emergency department (ED) patients undergoing CVC via IJV. Among the enrolled patients, 97 underwent SAVE, which consisted of 1) pre-CVC lung ultrasound, 2) ultrasound guided puncture of central vein, 3) sonographic detection of the guide wire before dilation, and 4) post-CVC lung ultrasonography. The primary outcome was the success rate of each stage. The secondary outcome was an estimated time of the SAVE exam. The entire process of patients' care was recorded by video for the purpose of time analysis. Physicians described anatomical site, reason for catheterization, and acute mechanical complications.
RESULTS
In all subjects, the guide wire was visible within the lumen of the IJV. Median access time, from insertion to detection of the guide wire in IJV via ultrasound, was 20 seconds. After the CVC was inserted, post-CVC lung ultrasonography was completed within a median time of 68 seconds. Identification of the chest x-ray image took more than 5 minutes. Acute mechanical complications - which occurred in three patients - were detected immediately by SAVE.
CONCLUSION
SAVE may provide greater safety during CVC by detection of CVC related complication more properly, without delay.