Evaluation of an ultrasound-guided technique for central venous access via the internal jugular vein in 493 patients.

Ultrasound guidance for percutaneous puncture of the internal jugular vein provides many advantages over the classic landmark-guided technique, particularly in complicated cases (e.g. thrombocytopenia, obesity, dyspnea). The present prospective investigation involved analysis of 493 punctures and provides patient- and operator-dependent variables with respect to the impact on puncture success and the complication rate. These 493 punctures of the internal jugular vein were performed using identical puncturing equipment and a standardized two-operator catheterization technique and were prospectively recorded on the hematology-oncology ward of a university hospital. Alongside success rates, the frequency and nature of complications, patient-inherent risk variables (obesity, thrombocytopenia, patient cooperation, vein diameter, etc.) and the individual experience of the physician performing the puncture and ultrasound were analyzed with respect to possible impact on success and complication rate. Internal jugular vein cannulation was successful in 94.5% of all patients. Catheter placement was successful at the first attempt in 87.6% of cases. Arterial fail punctures occurred in 1.4% of the patients and local hematoma in a further 4.3%. Among the patient-dependent variables, only poor patient compliance and a maximum vein diameter smaller than 7 mm showed a negative influence on the success rate. The experience of the physician carrying out the puncture influenced neither the success rate nor the complication rate. In contrast, both failure and complication rates were significantly lower when the physician guiding the sonographic probe was familiar with the method. Ultrasound-guided cannulation of the internal jugular vein provides safe central venous access with high success rates and low complication rates. Difficulties due to patient-inherent risk factors (e.g. thrombocytopenia, obesity, dyspnea) can be managed well using ultrasonographic guidance. The success rate achieved and the frequency of complications are decisively influenced not by the experience of the physician performing the puncture, but by the experience of the physician acting as sonographer.

[A standardized technique for ultrasound controlled placement of a central venous catheter]. / Eine standardisierte Technik zur ultraschallkontrollierten Applikation zentralvenöser Katheter.

To reduce the rate of complications and failures in central venous catheterisation a technique for ultrasonically controlled puncture of the internal jugular vein was standardised. The puncture procedure, including the application of local anaesthesia, is continuously observed and guided by real-time ultrasound. Imaging, control and practising of the puncture are described and discussed.

[Change in liver size caused by antitubercular combination therapy]. / Lebergrössenänderung unter antituberkulöser Kombinationstherapie.

In 23 patients undergoing antituberculous combination treatment, an ultrasonographic study of the dimensions of the liver was carried out every two weeks for the first two to three months of treatment. Starting with the fourth to sixth week on the therapeutic regimen, significant increases in the width of the left, and the length of the right liver lobes amounting to an average of 1 cm (11%) were established. Differences in the time course of changes in liver size were not to be found, neither in connection with adverse reactions, nor as a function of sex. Between the age of the patient and the depth parameters of the right liver lobe, however, significant positive regressions were observed with the course of treatment. Patients older than 40 years experienced a more marked increase in liver size under therapy. Patients with a history of alcohol abuse and those with side effects, have, on average, larger livers. Slow acetylators manifest a slightly greater increase in the size of the liver during treatment than do rapid acetylators. None of the patients investigated revealed any clinically relevant hepatotoxic side effects. There was no strict correlation between transient transaminase elevations and ultrasonographic changes in the hepatic architecture.

[Reproducibility of sonographic measurements in the follow-up of liver size]. / Die Reproduzierbarkeit sonographischer Messungen in der Verlaufskontrolle der Lebergrösse.

Liver diameters determined in various standardised sonographic section planes are investigated concerning their reproductiveness and validity in controls of liver size. The most reliable parameters proved to be the length in the posterior axillary line, the maximised depths of the right lobe at the portal branching and at the venous confluence, and the maximised length, breadth and thickness of the left lobe. Accuracy is improved by mean values calculated from the diameters of the adjacent longitudinal sections in the axillary lines and of the maximised depth sections of the right lobe. There are no significant differences of liver diameters caused by methodical aberrations, which are found to be 0.5-1.5%, whereas individual variations of the diameters are differentiated by the method. Correlations of the various liver diameters are investigated.

[Sonographic diagnosis of arterial occlusive disease]. / Sonographische Diagnose der arteriellen Verschlusskrankheit.

In 32 patients presenting symptoms of arterial occlusive disease, 50 lower limbs were examined both by ultrasonography and angiography (DSA). Sonography was performed using a 5.0 MHz real-time scanner; common femoral, superficial femoral and deep femoral arteries were visualized continuously in whole length. In 84% both the results from sonography and digital subtraction angiography verified or excluded arterial occlusion. Since lack of pulsation is the ultrasonic criterion of occlusion, real-time ultrasound does not differentiate between haemodynamically effective high-grade stenosis and total occlusion.

[Blood flow through different tissues under clonidine in rabbits (author's transl)]. / Die Durchblutung verschiedener Gewebe des Kaninchens unter Clonidin

The effect of i.v. administered clonidine on the blood flow through different tissues was investigated in six rabbits which had been anaesthetized with NembutalR. Six additional animals served as controls and received an equal quantity of a physiological sodium chloride solution. The blood flow was determined by means of radioactively labelled microspheres just before as well as 15, 30 and 45 min after the administration of the drug or the placebo respectively. In most of the investigated tissues a considerable decrease in blood flow was observed 15 min after the injection of clonidine, whereas no effect was to be seen after administration of sodium chloride. For the first time after 30 min, and even more after 45 min the blood flow diminished as well in the control group. The flow-decreasing effect of clonidine occured in lung, skin, choroid, the small intestine, the triceps muscle, the ciliary body, iris, and white matter, whereas the opposite reaction was observed in liver (hepatic artery), retina and the optic nerve.