Ultrasound-guided central vascular interventions, comments on the European Federation of Societies for Ultrasound in Medicine and Biology guidelines on interventional ultrasound

Abstract

Central venous access has traditionally been performed on the basis of designated anatomical landmarks. However, due to patients' individual anatomy and vessel pathology and depending on individual operators' skill, this landmark approach is associated with a significant failure rate and complication risk. There is substantial evidence demonstrating significant improvement in effectiveness and safety of vascular access by realtime ultrasound (US)-guidance, as compared to the anatomical landmark-guided approach. This review comments on the evidence-based recommendations on US-guided vascular access which have been published recently within the framework of Guidelines on Interventional Ultrasound (InVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) from a clinical practice point of view.

Central venous catheterization in cancer patients with severe thrombocytopenia: Ultrasound‑guide improves safety avoiding prophylactic platelet transfusion

“…A prospective, randomized controlled trial powered to test the hypothesis of whether omitting forgoing platelet transfusion prior to US-guided CVC insertion leads to an equal occurrence of clinically relevant bleeding complications in patients with thrombocytopenia is currently recruiting (32). In conclusion, we agree with the review article reported in this journal that stated it is strongly recommended to use real-time US-guidance for central venous access (33) and we believe that US-guidance of CVC insertion procedures makes the difference in safety, also in thrombocytopenic patients avoiding prophylactic platelet transfusion.…”

A comparison of longitudinal and transverse approaches to ultrasound-guided axillary vein cannulation by experienced operators

“…A variety of situations need central venous access include the need to administer medications and to monitor hemodynamic status. In many cases, such as obesity, thoracic deformity, and emergency status, the landmark method is a challenge and has a high incidence of complications (1,2). In the central line placement with the application of ultrasound, the puncture under direct vision, can significantly reduce complications, including pneumothorax, arterial injury and nerve damage, significantly improve patient safety (3)(4)(5).…”

Traditional and ultrasound physical examinations: a hybrid approach to improve clinical care

“…27 Some factors related to the operator's experience and others related to the patient (i.e., obese body habitus, coagulopathies and urgency of the procedure) justify this rate. [28][29][30] The use of US for venous access was first described in 1978, but only for the purpose of marking the skin overlying the IJV. 31 However, only in the mid-eighties the use of real-time US guidance for IJV cannulation was first described.…”