Recommendations on the Use of Ultrasound Guidance for Central and Peripheral Vascular Access in Adults: A Position Statement of the Society of Hospital Medicine

Abstract

PREPROCEDURE 1) We recommend that providers should be familiar with the operation of their specific ultrasound machine prior to initiation of a vascular access procedure.2) We recommend that providers should use a highfrequency linear transducer with a sterile sheath and sterile gel to perform vascular access procedures.3) We recommend that providers should use twodimensional ultrasound to evaluate for anatomical variations and absence of vascular thrombosis during preprocedural site selection. 4)We recommend that providers should evaluate the target blood vessel size and depth during preprocedural ultrasound evaluation. TECHNIQUES General Techniques 5)We recommend that providers should avoid using static ultrasound alone to mark the needle insertion site for vascular access procedures. 6)We recommend that providers should use real-time (dynamic), two-dimensional ultrasound guidance with a high-frequency linear transducer for central venous catheter (CVC) insertion, regardless of the provider's level of experience. 7)We suggest using either a transverse (short-axis) or longitudinal (long-axis) approach when performing realtime ultrasound-guided vascular access procedures. 8)We recommend that providers should visualize the needle tip and guidewire in the target vein prior to vessel dilatation. 9) To increase the success rate of ultrasound-guided vascular access procedures, we recommend that providers should utilize echogenic needles, plastic needle guides, and/or ultrasound beam steering when available. Central Venous Access Techniques 10)We recommend that providers should use a standardized procedure checklist that includes the use of real-time ultrasound guidance to reduce the risk of central line-associated bloodstream infection (CLABSI) from CVC insertion. 11)We recommend that providers should use real-time ultrasound guidance, combined with aseptic technique and maximal sterile barrier precautions, to reduce the incidence of infectious complications from CVC insertion. 12)We recommend that providers should use realtime ultrasound guidance for internal jugular vein catheterization, which reduces the risk of mechanical and infectious complications, the number of needle passes, and time to cannulation and increases overall procedure success rates. 13)We recommend that providers who routinely insert subclavian vein CVCs should use real-time ultrasound guidance, which has been shown to reduce the risk of mechanical complications and number of needle passes and increase overall procedure success rates compared with landmark-based techniques. 14)We recommend that providers should use real-time ultrasound guidance for femoral venous access, which has been shown to reduce the risk of arterial punctures and total procedure time and increase overall procedure success rates. Peripheral Venous Access Techniques 15)We recommend that providers should use real-time ultrasound guidance for the insertion of peripherally inserted central catheters (PICCs), which is associated with

Point-of-care ultrasound and COVID-19

“…Multiple professional society guidelines recommend using ultrasound for central venous catheter and arterial catheter placement to improve the safety and success rate of the procedure. 25 Use of point-of-care ultrasound for procedural guidance is strongly recommended, even in facilities that do not use it diagnostically in patients with COVID-19 infection. Figure 3 provides guidance on the use of ultrasound machines for patients with confi rmed or suspected cases of COVID-19 infection.…”

Vascular Access Support Team: A Multi-Disciplinary Response to Optimise Patients’ Care during COVID-19 Pandemic

“…There have been several publications on central and peripheral access training as well as on volume, technical errors and decision making in this area. In times of crisis, concentrating tasks, such as line insertion, allows people to focus on one duty with improved outcomes [25][26][27]. Nearly 30% of our patients in this report were receiving ECMO and patients were often managed in units that were converted to critical care to manage the unprecedented demand.…”

Reconsidering the GAVeCeLT Consensus on catheter-related thrombosis, 13 years later

“…As a result, US guidance is currently recommended in all bundles aimed at catheterrelated complication prevention. 23,24 Is there any device or material that may intrinsically reduce the risk?…”