• W R Fry, G C Clagett, and P T O'Rourke.
• Department of Surgery, Penrose Hospital, Colorado Springs, Colo., USA. williamfry@centura.org
• Arch Surg Chicago. 1999 Jul 1;134(7):738-40; discussion 741.

HypothesisReal-time ultrasound guidance should increase the success rate and lower the complication rate of central venous access in patients with relative contraindications to having the procedure performed.DesignProspective case series.SettingA community-based tertiary care hospital.PatientsFifty-two patients were studied. Relative risks to central venous catheter insertion included (1) thrombosis or stenosis of central veins, (2) inherent or acquired anticoagulation abnormalities, (3) inability to assume a supine position, (4) hypovolemia, (5) obesity or altered anatomy, and (6) severe respiratory compromise.InterventionsReal-time ultrasound evaluation of the proposed vein to be cannulated, followed by real-time percutaneous central vein access.Main Outcome MeasuresSuccessful cannulation of a central vein.ResultsAll attempts at central vein cannulation were successful. No bleeding complications occurred. One pneumothorax occurred in an obese patient.ConclusionsUltrasound-guided central venous access is a helpful technique to gain venous access in difficult cases. Surgeons who perform central venous access procedures should become acquainted with the techniques involved. The techniques should be incorporated into currently developing ultrasound instruction courses for surgeons.

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