Ultrasonography as a guide during vascular access procedures and in the diagnosis of complications

Abstract

Vascular access used in the treatment of patients involves central and peripheral vein accesses and arterial accesses. Catheterization of central veins is widely used in clinical practice; it is a necessary part of the treatment of patients in various settings. The most commonly involved vessels are the internal jugular, subclavian, and femoral veins. The mechanical, infectious, and thrombotic complications of central venous catheterization are markedly reduced when the procedure is performed with real-time ultrasound guidance or (to a slightly lesser extent) ultrasound assistance. Ultrasound guidance is also used to create peripheral venous accesses, for catheterization of peripheral veins and for peripheral insertion of central venous catheters. In this setting, it increases the catheterization success rate, especially during difficult procedures (e.g., obese patients, children) and reduces complications such as catheter-related infections and venous thrombosis. Arterial cannulation is used for invasive monitoring of arterial pressure and for access during diagnostic or therapeutic procedures. Ultrasound guidance reduces the risk of catheterization failure and complications. It is especially useful for arterial catheterization procedures performed in the absence of a palpable pulse (e.g., patient in shock, ECMO). Imaging support is being used increasingly to facilitate the creation of vascular accesses under difficult conditions, in part because of the growing use of ultrasonography as a bedside procedure. In clinical settings where patients are becoming increasingly vulnerable as a result of advanced age and/or complex disease, the possibility to reduce the risks associated with these invasive procedures should motivate clinicians to acquire the technical skills needed for routine use of sonographic support during vascular access procedures. Keywords Vascular access Á UltrasoundRiassunto Gli accessi vascolari utilizzati nella cura dei pazienti comprendono gli accessi venosi centrali e periferici e gli accessi arteriosi. L'incannulamento di accessi venosi centrali è manovra largamente diffusa nella pratica clinica e si rende necessaria per la cura dei pazienti in molteplici contesti. I vasi centrali che usualmente vengono incannulati sono la vena giugulare interna, la vena succlavia e la vena femorale. Nell'incannulamento venoso centrale sia l'eco-assistenza che l'eco-guida real time, pur con una leggera superiorità di quest'ultima, riducono drasticamente le complicanze meccaniche, infettive e trombotiche. La guida ecografica viene utilizzata anche per l'accesso venoso periferico, per l'incannulamento di vasi periferici e di vasi centrali a inserzione periferica (PICC). In questo contesto la guida ecografica aumenta il successo della manovra di incannulamento soprattutto in condizioni di difficoltà, come avviene nei pazienti obesi o nei bambini, e diminuisce le complicanze quali le infezioni catetere correlate e le trombosi venose. L'incannulamento arterioso viene utilizzato per il monitoraggio cruent...

Supraclavicular Approach to Ultrasound-Guided Brachiocephalic Vein Cannulation in Children and Neonates

“…Most clinicians employ radiologic imaging to confirm the position (50), yet, no method is regarded as gold standard (13). Importantly, real-time US has also been demonstrated to be useful in determining the optimal catheter position and furthermore, US imaging is also useful as a screening test to diagnose catheter malposition and procedure-related complications such as thrombosis or pneumothorax (51). …”

Usefulness of Doppler waveform analysis before performing a complex procedure using femoral venous access

“…When performing short catheter‐related procedures, prior ultrasound confirmation of femoral vein puncture site patency, or guidance for needle location during the procedure, are usually sufficient . When the vein appears as an anechoic circle easily compressible with the transducer, it is regarded as patent .…”

An Accidental Arterial Puncture and Anticoagulation after Internal Jugular Vein Catheterization Resulting in Massive Hematoma and Airway Compromise

“…13 hours after insertion of the CVC, Heparin was re-started with a dose of 25.000 IE/24 h (= 21.7 IE/kg/h), followed by regular measurements of anti-Xa-activity. After measuring an anti-Factor Xa activity of 1.07 IU/ml There is compelling evidence that ultrasound-guided CVC insertion via the internal jugular veins is associated with higher success rate and fewer mechanical complications compared with the traditional techniques based on external anatomical landmarks [5][6][7].…”

“…Other risk factors that are known to increase the incidence of complications are an inexperienced operator, the presence of anatomical variants as well as co-existing medical conditions such as clotting disorders, pulmonary emphysema, hypovolemia, or difficulties related to conditions under which the procedure is performed (i.e. an emergency) [5]. …”

“…Pneumothorax, hematothorax, arterial puncture, hematoma, nerve lesions, damage to the left thoracic duct, and air embolism are among the main mechanical complications [5]. The incidence of complications increase 6-fold after the third insertion attempt [1].…”