Ultrasound-guided cannulation of the femoral vein for acute haemodialysis access.

BACKGROUND: Central venous access is a mandatory part of patient management in many clinical settings and is usually achieved with a blind, external landmark-guided technique. The purpose of this study is to evaluate whether an ultrasound technique can improve on the external landmark method.

METHODS: We prospectively evaluated an ultrasound-guided method in 28 patients undergoing femoral vein cannulation for acute haemodialysis access and compared the results with 38 patients in whom an external landmark-guided technique was used. External landmark-guided technique was done by manual localization of the femoral artery in the femoral triangle inferior to the inguinal ligament with needle insertion medial to the artery. Ultrasound-guided cannulation was performed in the same location with the aid of an ultrasound device (Site-Rite, Dymax Corp., USA) with a 7.5 MHz transducer covered by a sterile sheath.

RESULTS: Cannulation of the femoral vein was achieved in all patients (100%) using ultrasound and in 34 patients (89.5%) using the landmark-guided technique. The vein was entered on the first attempt in 92.9% of patients using ultrasound and in 55.3% using the landmark technique (P < 0.05). Average access time (skin to vein) was similar but total procedure time was 45.1 +/- 18.8 s by the ultrasound approach and 79.4 +/- 61.7 s by the landmark approach (P < 0.05). Using ultrasound, puncture of the femoral artery occurred in 7.1% of patients, and haematoma in 0%. Using external landmark technique, puncture of the femoral artery occurred in 15.8% of patients, and haematoma in 2.6%.

CONCLUSIONS: Ultrasound-guided cannulation of the femoral vein reduces the time required for the procedure, reduces the number of passes needed to puncture the vein, and minimizes complications such as arterial puncture or haematoma.