The role of ultrasonographic advanced needle technologies in central jugular venous catheter applications

Introduction Emergency departments are the units in which a large number of critical patients are examined. Instant critical decisions regarding diagnosis and treatment in the patient care process are important for emergency physicians and patients. In this diagnosis and treatment process, ultrasonography is one of the most frequently used imaging methods by physicians. Features of ultrasonography such as portability, dynamic use, practical application and being harmlessness to the patient provide priority to ultrasonography in diagnosis and treatment process. Ultrasonography has been created in the literature with an imaging method by applying interventional procedures to reduce complications and increase success rates. It is thought that the newly developed ultrasonography with an advanced needle technology will reduce the procedure time and complications and increase the success rates. However, studies have done with these methods are very few and have been applied on models. In the study, it is aimed to investigate the superiority of new ultrasonography with advanced needle technology in terms of operation time, complication and success rates compared to standard 2-D ultrasonography. Method Patients were included to the study who applied to the Ege University Hospital Emergency Service between November 2016 - May 2017 with requirement of central venous access. Internal jugular catheter were inserted to 64 patients with the standard 2-D ultrasonography device, 36 patients with Axotrack ultrasonography device, 32 patients with advanced needle technology ultrasonography device with approval of the patients and/or relatives. Case numbers, current diseases, drugs they used, height-weight values, vitals were recorded for every single patients. The practitioner who performed the catheter, evaluated the suitability of the patient's neck for placement of the catheter as difficult or easy. Success and complication status, number of interventions, duration of the procedure were recorded in the case report form and satisfaction of the physician with the process was determined in the catheter application process. The obtained data were compared with appropriate techniques. Results Hematomic complications developed in 23.4% (15 people) of the patients with catheter inserted by 2-D usg, 22.2% (8 people) of the patients by Axotrack usg and 9.4% (3 people) of the patients by advanced needle technology usg. Artery puncture was developed in 6.3% (4 people) of 2-D usg-catheterized, 8.3% (3 persons) patients were catheterized with Axotrack usg and 3.1% (1 person) patients treated with advanced needle technology usg. 23.4% (5 people) of physicians using 2-D usg technique rated 5, 21.9% (14 people) 6 and 17.2% (11 people) 4 satisfaction points. 75.0% (27 people) of those using Axotrack usg technique rated 1 while %19.4 (7 people) rating 2 points. 31.3% (10 people) of the physicians rated 7 points, 28.1% (9 people) rated 8 and 18.8% (6 people) rated 6 points using advanced needle technology usg technique. 92.2% (59 people) of the patients using the 2-D usg technique have success. 5.6% of the patients using Axotrack usg technique (2 people) have success. 100% (32 people) of patients using the advanced needle technology usg technique have success. Discussion Central venous catheter applications should be performed in the presence of ultrasonography. It is aimed to decrease the complication and procedure time and increase the success rates with advanced needle technology ultrasonography. In the study, advanced needle technology ultrasonography is obtained better results such as initial entery success, practicioner satisfaction, procedure time and success rate when it is compared to 2-D ultrasonography and the complication rates were similar in all three techniques. There are few studies on the model with advanced needle technology ultrasonography. Real patient studies should be done with these new technologies and the development of techniques should be continued. It is aimed to decrease complications with developed new methods and to increase patient and physician comfort.