tral venous catheter insertion: a scoring system for evaluation of both the procedure and the operator

Sayed Gaber and Ahmed Samir.,Critical care department,Cairo university
INTRODUCTION  
 The preference between the landmark technique and the ultrasound guidance for CVCs insertion in ICU has some debate.  We tried to initiate a new scoring system for evaluation of different techniques in comparison as well as the operator. 

Methods: 400  consecutive patients admitted to the Critical Care Unit. These patients have been indicated for insertion of central venous catheter. They have been randomly divided into two equal groups: GROUP (A): Two hundreds patients, in whom catheterization of Internal Jugular Vein (IJV) was done using the two different techniques. GROUP (B): Two hundreds patients, in whom catheterization of Subclavian Vein (SV) was done using the two different techniques.

Results: Group A (IJV): The landmark group (Group A1) included 100 patients with a mean age of 65.13 ± 12.80 years old. However, in the ultrasound group (Group A2), the number of patients was 100 patients with a mean age of 62.23 ± 11.19 years old. Group B (SV): The landmark group (Group B1) included 100 patients with a mean age of 59.31 ± 13.99 years old. However, in the ultrasound group (Group B2), the number of patients was 100 patients with a mean age of 61.02 ± 12.64 years old. There were no significant differences between landmark groups and ultrasound groups according to age, sex, and BMI.
 According to our suggested scoring system for CVC insertion, In Group A, 20 % of patients in the landmark group achieved score 4 while 82 % of patients in the ultrasound group achieved the same score.  In Group B, there were 70 % of patients in the landmark group achieved score 5, in contrast to, 49 % of patients in the ultrasound group achieved the same score (P = 0.002), 
  There were 9 % of patients in the landmark group achieved score 6, in contrast to 30 % of patients in the ultrasound group achieved the same score (P <0.001), which suggests that the ultrasound technique could be better than the landmark Technique .
  
Key words: central venous catheter (CVC), subclavian vein (SV), internal jugular vein (IJV), ultrasound guidance