In plane ultrasound-guided central line placement is preferred over out-of-plane technique

by Joseph Esherick, M.D., FAAFP, FHM

A study from an urban EM residency program determined that in-plane ultrasound-guided central venous catheterization is superior to out-of-plane ultrasound-guided central line placement.

This study was only a single center study that was a randomized crossover study of ER residents using human torso manequins to test whether the long-axis view (in-plane technique) or the short-axis view (out-of-plane technique) was superior for central line placement.  The investigators were particularly concerned with the number of needle redirections, time to vein cannulation, and the incidence of posterior wall penetration.

The in-plane technique was associated with a significant number of needle redirections for both the internal jugular and the subclavian vein approach (RR = 0.4) and had a lower incidence of posterior wall penetration for sublavian vein cannulation (39% vs 64%).  The in-plane technique also had a shorter time to achieve subclavian vein cannulation compared with the out-of-plane technique.  There was no difference in time and posterior wall penetration between the two techniques for the IJ approach. 

This is an interesting study but it is a single center study on mannequins and tested EM resident physicians.  Of note, there was a very high rate of posterior wall penetrations which is likely related to the experience level of the participants.

Nevertheless, the study does have some interesting results and would like to see the study repeated with practicing physicians.

ultrasound-guided central line placement

Reference:

Critical Care Medicine. 2015; 43 (4): 832-8.