Conference Reports and Expert Panel

Intensive Care Medicine

, Volume 38, Issue 7, pp 1105-1117

International evidence-based recommendations on ultrasound-guided vascular access

  • Massimo LampertiAffiliated withDepartment of Neuroanesthesia, Neurological Institute Besta Email author 
  • , Andrew R. BodenhamAffiliated withAnesthesiology, Leeds General Infirmary
  • , Mauro PittirutiAffiliated withDepartment of Surgery, Catholic University
  • , Michael BlaivasAffiliated withDepartment of Emergency Medicine, Northside Hospital Forsyth
  • , John G. AugoustidesAffiliated withAnesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania
  • , Mahmoud ElbarbaryAffiliated withNational and Gulf Center for Evidence Based Health Practice, King Saud University for Health Sciences
  • , Thierry PirotteAffiliated withDepartment of Anesthesia and Intensive Care Medicine, Cliniques Universitaires Saint-Luc
  • , Dimitrios KarakitsosAffiliated withIntensive Care Unit, General State Hospital of Athens
  • , Jack LeDonneAffiliated withGreater Baltimore Medical Center
    • , Stephanie DonigerAffiliated withDepartment of Neuroanesthesia, Neurological Institute BestaPediatric Emergency Medicine, Children’s Hospital and Research Center
    • , Giancarlo ScoppettuoloAffiliated withDepartment of Neuroanesthesia, Neurological Institute BestaInfectious Diseases Unit, Catholic University
    • , David Feller-KopmanAffiliated withDepartment of Neuroanesthesia, Neurological Institute BestaBronchoscopy and Interventional Pneumology, Johns Hopkins Hospital
    • , Wolfram SchummerAffiliated withDepartment of Neuroanesthesia, Neurological Institute BestaDepartment of Anesthesiology and Intensive Care Medicine, SHR Zentralklinikum Suhl
    • , Roberto BiffiAffiliated withDepartment of Neuroanesthesia, Neurological Institute BestaDivision of Abdominopelvic Surgery, European Institute of Oncology
    • , Eric DesruennesAffiliated withDepartment of Neuroanesthesia, Neurological Institute BestaDepartment of Anesthesia, Institute Gustave Roussy
    • , Lawrence A. MelnikerAffiliated withDepartment of Neuroanesthesia, Neurological Institute BestaDepartment of Emergency Medicine, New York Methodist Hospital and Clinical Epidemiology Unit
    • , Susan T. VergheseAffiliated withDepartment of Neuroanesthesia, Neurological Institute BestaDepartment of Anesthesiology, Children’s National Medical Center

Abstract

Purpose

To provide clinicians with an evidence-based overview of all topics related to ultrasound vascular access.

Methods

An international evidence-based consensus provided definitions and recommendations. Medical literature on ultrasound vascular access was reviewed from January 1985 to October 2010. The GRADE and the GRADE-RAND methods were utilised to develop recommendations.

Results

The recommendations following the conference suggest the advantage of 2D vascular screening prior to cannulation and that real-time ultrasound needle guidance with an in-plane/long-axis technique optimises the probability of needle placement. Ultrasound guidance can be used not only for central venous cannulation but also in peripheral and arterial cannulation. Ultrasound can be used in order to check for immediate and life-threatening complications as well as the catheter’s tip position. Educational courses and training are required to achieve competence and minimal skills when cannulation is performed with ultrasound guidance. A recommendation to create an ultrasound curriculum on vascular access is proposed. This technique allows the reduction of infectious and mechanical complications.

Conclusions

These definitions and recommendations based on a critical evidence review and expert consensus are proposed to assist clinicians in ultrasound-guided vascular access and as a reference for future clinical research.

Keywords

Central venous access Ultrasound guidance Arterial cannulation Vascular access Critical care ultrasound RAND GRADE Guideline Evidence-based medicine