Ultrasound-Based SECURED Protocol for Central Venous Catheterization: A Feasibility Study.

backgroundCentral venous catheterization (CVC) is essential for managing critically ill patients but is associated with potential mechanical complications. Although ultrasound-guided (USG) CVC is widely used, its application is often fragmented, focusing primarily on needle guidance. We developed and evaluated the "Standardized Evaluation of Central venous catheterization using Ultrasound for Risk Elimination and Detection" (SECURED) protocol, which integrates validated point-of-care ultrasound (POCUS) techniques into a unified, six-step sequential workflow.

methodsThis prospective observational study enrolled 109 adult patients undergoing internal jugular vein (IJV) CVC in the emergency department (ED). The SECURED protocol consists (1) Pre-CVC IJV scan, (2) Pre-CVC pleural scan, (3) USG IJV puncture, (4) Guidewire insertion and confirmation, (5) Post-CVC pleural scan, and (6) Post-CVC cardiac scan with microbubbles. The primary endpoint was the protocol completion rate, whereas the secondary endpoint was a comparison of the time required for ultrasound-based complication detection versus portable chest radiography.

resultsThe SECURED protocol achieved a 100% completion rate across all 109 cases. The protocol successfully identified one case of preexisting IJV thrombosis, prevented the progression of two arterial punctures, and detected one venous dissection during the procedure. Furthermore, the protocol enabled rapid detection of post-CVC complications, identifying one pneumothorax and two catheter tip malpositions. The median time required to confirm pneumothorax and catheter tip malposition using the SECURED complication-detection steps was significantly shorter than that with chest radiography (2.5 min [95% CI: 2.3-2.8] vs. 12.4 min [95% CI: 11.1-13.7]; p < 0.001).

conclusionsThe SECURED protocol is a practical and highly time-efficient screening framework that bridges the gap between fragmented ultrasound adjuncts and standardized clinical practice. By enabling proactive hazard detection and immediate postprocedural confirmation, it serves as a feasible screening tool that streamlines clinical decision-making in the ED. Following further validation through larger, multicenter studies with comparative designs to evaluate its clinical efficacy and safety benefits, broader implementation of this protocol across various clinical settings could be considered.