Comparing the Complications in Central Venous Catheterization by Ultrasound Guidance vs Anatomical Landmark Technique in Critical Ill ICU Patients

Abstract

Objective: To compare the complication rates during central venous catheterization using ultrasound guidance versus the anatomical landmark technique in critical ill ICU patients.

Methodology: A prospective comparative study was conducted in intensive care unit (ICU) of Farooq Teaching Hospital, Rawalpindi from December 2023 to June 2024. Total 127 critically ill ICU patients with acute surgical or medical conditions requiring central venous catheterization (CVC), such as hypotension, dehydration, or required blood resuscitation, where periphery approach was not feasible, underwent CVC insertion. Patients were randomly divided into two groups: one group underwent ultrasound-guided CVC insertion, while the other group used anatomical landmark technique. The rate of complications was measured between the groups.

Results: Mean age of the patients was 46.5±11.2 years. The mean time from skin puncture to blood flashback was 104±172 sec in ultrasound group compared to 401±587 sec in landmark group. Among 127 patients, 61 underwent catheterization using ultrasound guidance, while 66 underwent catheterization using the anatomical landmark technique. The complication rates between the two groups were compared. The complications experienced by patients included multiple attempts (>1 puncture), pneumothorax, improper cannulation, hematoma, arterial punctures, incisional bleeding, and ecchymosis. In ultrasound group, 11.5% of patients experienced complications, compared to 28.8% in anatomical landmark group (p = 0.016).

Conclusion: Ultrasound-guided central venous catheterization was associated with fewer complications and a higher success rate (correct placement of the CVC), making it easier to perform. This procedure simplicity is linked to enhanced safety and patient comfort.