The factors affecting the success of the central vein catheterization in the emergency service and the effect of pre-process vascular assessment on procedural success

Introduction and Aim: Central venous catheter (CVC) is a cannula that is placed inside the central vein in need of a wide vascular access. Central venous catheter (CVC) insertion can assist in the diagnosis and treatment of critical diseases. The most common indications of a central venous catheter in the emergency service are fluid treatment in hypovolemia or shock, infusion of blood and blood products, infusion of hypertonic drugs and fluids, large surgical operations where excessive blood loss is expected, the patient who isn't established vascular access with the peripheral vein, pacemaker insertion, and a need for wide vascular access to emergency hemodialysis. Increasing technical developments and better understanding of the human anatomy make central vein catheterization attempts easier, faster and safer; however, some risks are still likely to occur. In this study, we aimed to investigate whether or not the effect of static ultrasonographic vascular evaluation on catheterization success and patient benefit examining the vascular size, obstruction, anatomical structural differences and anomalies before central venous catheter placement and to reveal the other factors affecting the success of the central vein catheterization in the emergency service. Material and Method: This study was performed as a prospective and cross-sectionally between January 1, 2019 - January 31, 2020, in the Department of Emergency Medicine at Balcalı Hospital with the approval of Çukurova University Faculty of Medicine Ethics Committee. 67 patients who admitted to the Adult Emergency Medicine Service within the specified time period, who needed central vein catheterization and who had the inclusion criteria, were included in the study. 33 of these patients were examined by static ultrasonography to evaluate vascular structures before central vein catheter placement. Sociodemographic data, vital signs, laboratory findings, study parameters and procedure data of the patients and data related research assistants who made central vein catheterization were recorded in the previously prepared study sheet. Research data was uploaded and analyzed on computer via "SPSS for Windows 21.0 (SPSS Inc, Chicago, IL)". Results: A total of 67 patients were included in the study. The average age of all patients was 52.3±16.7 years and 73.1% (n = 49) of the patients were male. Central vein catheters were placed in 33 patients using static USG technique and 34 patients using anatomic landmark technique. The most common reason for placing CVC in both patient groups was hemodialysis due to poisoning (Static USG group: 48.5% and Anatomic Landmark group: 64.7%). There was no statistically significant difference between the patient groups in terms of sociodemographic data. As a statistically significant, it was shown to increase the process success rate (p=0,001), decrease the total number of interventions (p=0,001), and reduce the problems that occur after the procedure (p=0,048) by using static USG examination. When the number of catheters used, the time elapsed between skin to blood aspiration during CVC placement and the number of physicians performing the procedure were compared, there was no statistically significant difference between patient groups. Discussion and Conclusions: As a statistically significantly, it was shown that a high success rate, less post-procedure catheter dysfunction development, and fewer attempts were achieved in CVC placement procedures with static USG technique. In addition, although it wasn't statistically significant, it was shown that performing a static USG examination before CVC placement shortened the time spent during CVC placement, decreased the number of catheters used and decreased the number of research assistants who tried the procedure. It was seen that the total time spent for CVC placement was statistically significantly higher in the static USG group. The effects of static USG technique on central vein catheterization success can be more clearly demonstrated by further studies with more patients. Keywords: Catheterization, Central vein catheter, Emergency service, Static ultrasonography.