ORIGINAL ARTICLE
Development and Evaluation of a Program for the Use of Ultrasound for Central Venous Catheter Placement in a Pediatric Emergency Department Rebecca L. Vieira, MD, RDMS, Rachel A. Gallagher, MD, RDMS, Anne M. Stack, MD, Heidi C. Werner, MD, and Jason A. Levy, MD, RDMS
Background: A growing body of literature supports the use of ultrasound (US) to assist central venous catheter (CVC) placement, and in many settings, this has become the standard of care. However, this remains a relatively new and uncommonly performed procedure for pediatric emergency medicine physicians. Objectives: This study aims to describe the change over time in percentage of CVC procedures performed with US assistance per 10,000 patient visits in a pediatric emergency department. Methods: We describe the development of an emergency US program in a pediatric emergency department and investigate how US use for CVC placement in internal jugular and femoral veins changed from July 2007, when US became available, until December 2011. Data related to CVC procedures were obtained from a procedure database maintained for quality assurance purposes. Results: The percentage of CVC procedures performed with US assistance increased significantly over time (P G 0.001). Conclusions: The development of an emergency US program was associated with significantly increased physician use of US for CVC placement. Key Words: emergency ultrasound, bedside ultrasound, central venous catheter (Pediatr Emer Care 2013;29: 1245Y1248)
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hysicians resuscitating critically ill or injured pediatric patients may attempt central venous catheter (CVC) placement in the emergency department (ED). Traditionally, percutaneous insertion of CVCs has been performed using visualization and palpation of anatomic structures to direct needle position and catheter placement, referred to as the landmark technique. More recently, physicians in a wide variety of settings have used ultrasound (US) to guide CVC placement. Ultrasound offers the advantage of real-time visualization of the vessels, needle, and other important structures during the procedure. In 2001, the Agency for Healthcare Research and Quality (AHRQ) identified US assistance for CVC placement as one of the top ‘‘highly recommended’’ practices to improve patient safety.1 Since then, a growing body of literature supports the use of US-assisted CVC placement, and in some settings, this has become the standard of care.2Y9 Bedside US is relatively new to pediatric emergency medicine (PEM).10,11 Although the technology is becoming From the Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA. Disclosure: The authors declare no conflict of interest. Reprints: Rebecca L. Vieira, MD, RDMS, Division of Emergency Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 (e
Development and Evaluation of a Program for the Use of Ultrasound for Central Venous Catheter Placement in a Pediatric Emergency Department Rebecca L. Vieira, MD, RDMS, Rachel A. Gallagher, MD, RDMS, Anne M. Stack, MD, Heidi C. Werner, MD, and Jason A. Levy, MD, RDMS
Background: A growing body of literature supports the use of ultrasound (US) to assist central venous catheter (CVC) placement, and in many settings, this has become the standard of care. However, this remains a relatively new and uncommonly performed procedure for pediatric emergency medicine physicians. Objectives: This study aims to describe the change over time in percentage of CVC procedures performed with US assistance per 10,000 patient visits in a pediatric emergency department. Methods: We describe the development of an emergency US program in a pediatric emergency department and investigate how US use for CVC placement in internal jugular and femoral veins changed from July 2007, when US became available, until December 2011. Data related to CVC procedures were obtained from a procedure database maintained for quality assurance purposes. Results: The percentage of CVC procedures performed with US assistance increased significantly over time (P G 0.001). Conclusions: The development of an emergency US program was associated with significantly increased physician use of US for CVC placement. Key Words: emergency ultrasound, bedside ultrasound, central venous catheter (Pediatr Emer Care 2013;29: 1245Y1248)
P
hysicians resuscitating critically ill or injured pediatric patients may attempt central venous catheter (CVC) placement in the emergency department (ED). Traditionally, percutaneous insertion of CVCs has been performed using visualization and palpation of anatomic structures to direct needle position and catheter placement, referred to as the landmark technique. More recently, physicians in a wide variety of settings have used ultrasound (US) to guide CVC placement. Ultrasound offers the advantage of real-time visualization of the vessels, needle, and other important structures during the procedure. In 2001, the Agency for Healthcare Research and Quality (AHRQ) identified US assistance for CVC placement as one of the top ‘‘highly recommended’’ practices to improve patient safety.1 Since then, a growing body of literature supports the use of US-assisted CVC placement, and in some settings, this has become the standard of care.2Y9 Bedside US is relatively new to pediatric emergency medicine (PEM).10,11 Although the technology is becoming From the Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA. Disclosure: The authors declare no conflict of interest. Reprints: Rebecca L. Vieira, MD, RDMS, Division of Emergency Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 (e
