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The importance of training for ultrasound guidance in central vein catheterization.

OBJECTIVE
To review the complication and success rates associated with CVC placement in patients undergoing cardiovascular surgery depending on the technique utilized and the degree of ultrasound experience of the anesthesia provider.


DESIGN
Randomized controlled trial.


SETTING
Operating room and post anesthesia care unit.


PATIENTS
325 patients with CAD requiring cardiovascular surgery with an ASA of III or above.


INTERVENTIONS
The subjects underwent CVC of the Internal Jugular vein with or without ultrasound guidance in preparation for cardiovascular surgery.


MEASUREMENTS
Utilization of US, carotid artery puncture/cannulation and the presence of post procedure pneumothorax.


RESULTS
When comparing the group that had CVC without US versus the group having CVC placement with US, there was significant difference in complication rates based on Z-testing (95% confidence level). Furthermore, with 90% confidence (based on Z-testing) there was a significant difference in complication rates between the experienced and non experienced US practitioners.


CONCLUSIONS
With adequate US training, the complications from CVC including carotid artery puncture and pneumothorax can be significantly reduced.