Ultrasound guidance for vascular access

Abboud, Paul-André C.; Kendall, John L.

doi:10.1016/j.emc.2004.04.003

Cited by 81 publications

(71 citation statements)

References 81 publications

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“…The needle should be held at an angle of 45°relative to the skin surface and out-of-plane relative to the transducer [26]. The operator should attempt to identify the needle, represented by a white or gray dot, although in some cases visualization is limited to the deformation of tissue and artifacts produced by the needle's advancement.…”

Section: Equipment and Techniquementioning

confidence: 99%

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

et al. 2013

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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...

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Section: Equipment and Techniquementioning

confidence: 99%

“…The difficulty is related to the vein's course beneath the clavicle, which tends to shield it from the ultrasound beam. This limitation can be overcome, however, using a more lateral approach, beyond the first rib, closer to the shoulder, where the axillary vein merges with the subclavian vein [26,35].…”

Section: Subclavian Veinmentioning

confidence: 99%

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

et al. 2013

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“…5 However, with the advent of ultrasonography, real-time fluoroscopy and contrast fluoroscopy, the reliability of the procedure is reported to increase significantly, with lower failure rate, complication rate, and number of attempts required for successful access. 6 In our case, puncture site being just below the inguinal ligament, inadvertent advancement of the needle would have led to the entry into the peritoneal cavity. Haemoperitoneum may have led to free back flow of blood initially.…”

Section: Discussionmentioning

confidence: 99%

Accidental intraperitoneal malpositioning of femoral central venous catheter: Learning from mistakes

John¹,

Lagoo

2016

Sri Lankan J Anaesthesiol

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A large number of central venous catheters (CVC) are placed each year in the emergency room, operation theatre and critical care unit. Although rarely associated with life threatening complications, femoral CVC is known to have the highest incidence of mechanical complications. It is important that clinicians are aware of wrong positioning of CVC even in the presence of good backflow of blood through all the lumens, especially in patients with haemo peritoneum. This article outlines a rare complication of misplaced femoral CVC into the peritoneal cavity in a patient with haemo peritoneum, its consequences and management. We further want to emphasize the importance of real time imaging during CVC insertion to improve safety and reduce complications rate.

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“…1,5,7 The benefits include a reduced rate of complications and failure, a reduced number of attempts, and a faster performance time. [21][22][23][24] These results are due to visualization of the needle and its position relative to the structures. In addition, 2D ultrasound helps to predict anatomical variations and confirms the patency of the internal jugular vein.…”

Section: Benefitsmentioning

confidence: 99%

Ultrasound guidance for internal jugular vein cannulation: Continuing Professional Development

Ayoub

Lavallée

Denault

2010

Can J Anesth/J Can Anesth

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Purpose The objective of this continuing professional development module is to describe the role of ultrasound for central venous catheterization and to specify its benefits and limitations. Although ultrasound techniques are useful for all central venous access sites, the focus of this module is on the internal jugular vein approach. Principal findings In recent years, several studies were published on the benefits of ultrasound use for central venous catheterization. This technique has evolved rapidly due to improvements in the equipment and technology available. Ultrasound helps to detect the anatomical variants of the internal jugular vein. The typical anterolateral position of the internal jugular vein with respect to the carotid is found in only 9-92% of cases. Ultrasound guidance reduces the rate of mechanical, infectious, and thrombotic complications by 57%, and it also reduces the failure rate by 86%. Cost-benefit analyses show that the cost of ultrasound equipment is compensated by the decrease in the expenses associated with the treatment of complications. In this article, we will review the history of ultrasound guidance as well as the reasons that account for its superiority over the classical anatomical landmark technique. We will describe the equipment needed for central venous catheterization as well as the various methods to visualize with ultrasound. Conclusion To improve patient safety, we recommend the use of ultrasound for central venous catheterization using the internal jugular approach. ObjectivesAfter reading this module, the reader will be able to:1. Understand the rationale behind the use of ultrasound for central venous catheterization; 2. Identify anatomical variations in vascular structures in the neck; 3. Recognize the benefits and limitations related to the use of ultrasound; and 4. Adopt an ultrasound-guided approach in everyday practice.Over the years, anesthesiologists have adopted new technologies that are used for clinical monitoring and intraoperative diagnosis as well as for performing various techniques. These advances assist the anesthesiologist in performing procedures that may be associated with significant complications. One such procedure is central venous catheterization, which can be simplified and made safer with ultrasound. The main objective of this article is to explain the scientific and clinical foundations supporting the role of ultrasound in central venous catheterization. We will focus exclusively on the internal jugular vein approach. 123 Can J Anesth/J Can Anesth (2010) 57:500-514 DOI 10.1007/s12630-010-9291-7 Historical perspectiveThe main indications for central venous catheterization in the operating room or intensive care unit (ICU) include central venous pressure monitoring, the insertion of a pulmonary artery catheter, and the administration of drugs, such as antibiotics, vasopressors, inotropes, and chemotherapeutic agents. These catheters are also used to administer parenteral nutritional support, and they are needed for procedures such as...

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Ultrasound guidance for vascular access

Cited by 81 publications

References 81 publications

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

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

Accidental intraperitoneal malpositioning of femoral central venous catheter: Learning from mistakes

Ultrasound guidance for internal jugular vein cannulation: Continuing Professional Development

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