Skip to main content
SpringerLink
Log in

Ultrasound for Vascular Access

  • Chapter
  • First Online:
Essential Echocardiography

  • 1552 Accesses

Abstract

Ultrasound can be employed to facilitate central and peripheral vascular access. In some cases, such as internal jugular vein cannulation, the use of ultrasound makes the procedure faster and safer, while limiting the number of attempts. In other cases, such as subclavian vein cannulation, the role of ultrasound in facilitating the procedure is less clear. Additionally, ultrasound can be utilized to confirm proper guidewire placement in the right atrium prior to central venous cannulation and aid in the placement of pulmonary artery catheters. While ultrasound has not yet been proven to decrease the time to placement of pulmonary artery catheters or reduce complications secondary to placement, it does facilitate real-time guidance and final positioning.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ASE:

American Society of Echocardiography

CA:

Carotid artery

CVC:

Central venous catheter

CVP:

Central venous pressure

FV:

Femoral vein

IJ:

Internal jugular (vein)

LAX:

Long-axis

PAC:

Pulmonary arterial catheter

SAX:

Short-axis

SC:

Subclavian (vein)

SCA:

Society of Cardiovascular Anesthesiologists

TEE:

Transesophageal echocardiography

TTE:

Transthoracic echocardiography

References

  1. Blaivas M, Brannam L, Fernandez E. Short-axis versus long-axis approaches for teaching ultrasound-guided vascular access on a new inanimate model. Acad Emerg Med. 2003;10:1307–11.

    Article  Google Scholar 

  2. Merrer J. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA. 2001;286:700.

    Google Scholar 

  3. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348:1123–33.

    Article  Google Scholar 

  4. Parienti JJ, Mongardon N, Mégarbane B, et al. Intravascular complications of central venous catheterization by insertion site. N Engl J Med. 2015;373:1220–9.

    Article  CAS  Google Scholar 

  5. Hosokawa K, Shime N, Kato Y, et al. A randomized trial of ultrasound image–based skin surface marking versus real-time ultrasound-guided internal jugular vein catheterization in infants. Anesthesiology. 2007;107:720–4.

    Article  Google Scholar 

  6. Milling TJ, Rose J, Briggs WM, et al. Randomized, controlled clinical trial of point-of-care limited ultrasonography assistance of central venous cannulation: the Third Sonography Outcomes Assessment Program (SOAP-3) trial*. Crit Care Med. 2005;33:1764–9.

    Article  Google Scholar 

  7. Schnadower D, Lin S, Perera P, et al. A pilot study of ultrasound analysis before pediatric peripheral vein cannulation attempt. Acad Emerg Med. 2007;14:483–5.

    Article  Google Scholar 

  8. Troianos CA, Hartman GS, Glas KE, et al. Guidelines for performing ultrasound guided vascular cannulation. Anesth Analg. 2012;114:46–72.

    Article  Google Scholar 

  9. Denys BG, Uretsky BF, Reddy PS. Ultrasound-assisted cannulation of the internal jugular vein. A prospective comparison to the external landmark-guided technique. Circulation. 1993;87:1557–62.

    Article  CAS  Google Scholar 

  10. Karakitsos D, Labropoulos N, De Groot E, et al. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care. 2006;10:R162.

    Google Scholar 

  11. Troianos CA, Jobes DR, Ellison N. Ultrasound-guided cannulation of the internal jugular vein. A prospective, randomized study. Anesth Analg. 1991;72:823–6.

    Article  CAS  Google Scholar 

  12. Bellazzini MA, Rankin PM, Gangnon RE, et al. Ultrasound validation of maneuvers to increase internal jugular vein cross-sectional area and decrease compressibility. Am J Emerg Med. 2009;27:454–9.

    Article  Google Scholar 

  13. Terai C, Anada H, Matsushima S, et al. Effects of mild Trendelenburg on central hemodynamics and internal jugular vein velocity, cross-sectional area, and flow. Am J Emerg Med. 1995;13:255–8.

    Article  CAS  Google Scholar 

  14. Blaivas M, Adhikari S. An unseen danger: frequency of posterior vessel wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance*. Crit Care Med. 2009;37:2345–9.

    Article  Google Scholar 

  15. Stone MB, Hern HG. Inadvertent carotid artery cannulation during ultrasound guided central venous catheterization. Ann Emerg Med. 2007;49:720.

    Article  Google Scholar 

  16. Moak JH, Lyons MS, Wright SW, et al. Needle and guidewire visualization in ultrasound-guided internal jugular vein cannulation. Am J Emerg Med. 2011;29:432–6.

    Article  Google Scholar 

  17. Balls A, LoVecchio F, Kroeger A, et al. Ultrasound guidance for central venous catheter placement: results from the Central Line Emergency Access Registry Database. Am J Emerg Med. 2010;28:561–7.

    Article  Google Scholar 

  18. Gualtieri E, Deppe SA, Sipperly ME, et al. Subclavian venous catheterization. Crit Care Med. 1995;23:692–7.

    Article  CAS  Google Scholar 

  19. Lalu MM, Fayad A, Ahmed O, et al. Ultrasound-guided subclavian vein catheterization: a systematic review and meta-analysis. Crit Care Med. 2015;43:1498–507.

    Article  Google Scholar 

  20. Beaulieu Y. Bedside ultrasonography in the ICU *. Chest. 2005;128:1766.

    Article  Google Scholar 

  21. Hind D. Ultrasonic locating devices for central venous cannulation: meta-analysis. BMJ. 2003;327:361–0.

    Article  Google Scholar 

  22. Maddali MM, Arora NR, Chatterjee N. Ultrasound guided out-of-plane versus in-plane transpectoral left axillary vein cannulation. J Cardiothorac Vasc Anesth. 2017;31:1707–12.

    Article  Google Scholar 

  23. Tan B-K, Hong S-W, Huang MHS, et al. Anatomic basis of safe percutaneous subclavian venous catheterization. J Trauma. 2000;48:82.

    Article  CAS  Google Scholar 

  24. Iwashima S, Ishikawa T, Ohzeki T. Ultrasound-guided versus landmark-guided femoral vein access in pediatric cardiac catheterization. Pediatr Cardiol. 2007;29:339–42.

    Article  Google Scholar 

  25. Kwon T, Kim Y, Cho D. Ultrasound-guided cannulation of the femoral vein for acute haemodialysis access. Nephrol Dial Transplant. 1997;12:1009–12.

    Article  CAS  Google Scholar 

  26. Seto AH, Abu-Fadel MS, Sparling JM, et al. Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications. J Am Coll Cardiol Intv. 2010;3:751–8.

    Article  Google Scholar 

  27. Timsit JF, Baleine J, Bernard L, et al. Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit. Ann Intensive Care. 2020;10:118.

    Article  Google Scholar 

  28. Lamperti M, Biasucci DG, Disma N, et al. European Society of Anaesthesiology guidelines on peri-operative use of ultrasound-guided for vascular access (PERSEUS vascular access). Eur J Anaesthesiol. 2020;37:344–76.

    Article  Google Scholar 

  29. Frankel HL, Kirkpatrick AW, Elbarbary M, et al. Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-part I: general ultrasonography. Crit Care Med. 2015;43:2479–502.

    Article  Google Scholar 

  30. Levin PD, Sheinin O, Gozal Y. Use of ultrasound guidance in the insertion of radial artery catheters. Crit Care Med. 2003;31:481–4.

    Article  Google Scholar 

  31. Shiloh AL. Ultrasound-guided catheterization of the radial artery. Chest. 2011;139:524.

    Article  Google Scholar 

  32. Shiver S, Blaivas M, Lyon M. A prospective comparison of ultrasound-guided and blindly placed radial arterial catheters. Acad Emerg Med. 2006;13:1275–9.

    Article  Google Scholar 

  33. Sandhu NS, Patel B. Use of ultrasonography as a rescue technique for failed radial artery cannulation. J Clin Anesth. 2006;18:138–41.

    Article  Google Scholar 

  34. Keyes LE, Frazee BW, Snoey ER, et al. Ultrasound-guided brachial and Basilic vein cannulation in emergency department patients with difficult intravenous access. Ann Emerg Med. 1999;34:711–4.

    Article  CAS  Google Scholar 

  35. Sandhu NPS. Mid-arm approach to basilic and cephalic vein cannulation using ultrasound guidance. Br J Anaesth. 2004;93:292–4.

    Article  CAS  Google Scholar 

  36. Cronin B, Kolotiniuk N, Youssefzadeh K, et al. Pulmonary artery catheter placement aided by transesophageal echocardiography versus pressure waveform transduction. J Cardiothorac Vasc Anesth. 2018;32:2578–82.

    Article  Google Scholar 

  37. Turnage WS, Fontanet H. Transesophageal echocardiography-guided pulmonary artery catheter placement. Anesth Analg. 1993;77:858–9.

    Article  CAS  Google Scholar 

  38. Cronin B, Robbins R, Maus T. Pulmonary artery catheter placement using transesophageal echocardiography. J Cardiothorac Vasc Anesth. 2017;31:178–83.

    Article  Google Scholar 

  39. Fretwell D, Smith M, Martin E, et al. Epidural intravascular injection detection by transthoracic echocardiography. J Cardiothorac Vasc Anesth. 2020;34:1288–91.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, University of California San Diego Health, La Jolla, CA, USA

    Seth T. Herway & Brett Cronin

Authors
  1. Seth T. Herway
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brett Cronin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brett Cronin .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, University of California, San Diego Health, La Jolla, CA, USA

    Timothy M. Maus

  2. Department of Anesthesiology, University of California, San Diego Health, La Jolla, CA, USA

    Christopher R. Tainter

Electronic Supplementary Material

Out-of-plane or short-axis (SAX) imaging of the right internal jugular vein (MP4 13974 kb)

Out-of-plane or short-axis (SAX) imaging of a vessel, showing stepwise introduction of a needle, through serial parallel imaging planes (MP4 1406 kb)

In-plane or long-axis (LAX) imaging of the right internal jugular vein from the same patient in Video 23.1 (MP4 12320 kb)

In-plane or long-axis (LAX) imaging of a vessel, showing introduction of a needle from the left side of the screen (MP4 1355 kb)

Out-of-plane imaging (SAX view) of the right internal jugular vein with color flow Doppler. Color flow Doppler imaging demonstrates faster pulsatile laminar flow in the carotid artery with slower flow in the jugular vein (MP4 245 kb)

In-plane imaging (LAX view) of the right internal jugular with color flow Doppler (MP4 218 kb)

Short-axis imaging of right internal jugular vein with a wire within its lumen (MP4 308 kb)

Long-axis imaging of the right internal jugular vein with a wire noted to be within its lumen (no evidence of “backwall”) (MP4 317 kb)

Midesophageal bicaval view demonstrating the “J-tip” of the central access wire within the right atrium, confirming venous access (MP4 982 kb)

Short-axis imaging of the right subclavian artery and vein (MP4 277 kb)

Short-axis imaging of the femoral artery and vein (MP4 294 kb)

A. Short-axis imaging of the right radial artery (MP4 455 kb)

B. Short-axis imaging of the same patient with color flow Doppler imaging (MP4 380 kb)

Short-axis imaging of the left basilic vein (MP4 593 kb)

Modified subcostal 4-chamber view with a guidewire in the right atrium (MOV 1311 kb)

Descending aorta short-axis view (depth reduced) with the distal tip of an intra-aortic balloon pump in the lumen of the aorta (MOV 3853 kb)

Midesophageal modified bicaval view. A PAC with the balloon inflated is being advanced from the superior vena cava; then a slight counterclockwise rotation redirects it from the right atrial appendage to the tricuspid valve (MOV 6337 kb)

Midesophageal RV inflow-outflow view with a PAC (balloon inflated) being advanced from just below the tricuspid valve through the right ventricle and towards the pulmonic valve (MOV 9740 kb)

Subcostal basal short-axis view with a PAC traversing the tricuspid valve and right ventricle, with its distal tip positioned in the proximal right pulmonary artery (MOV 1763 kb)

Questions

Questions

  1. 1.

    The following image is obtained while attempting to place a radial arterial catheter. Which of the following is most true?

    1. A.

      This site is not suitable, because the radial artery is occluded

    2. B.

      The depth should be increased

    3. C.

      The angle of the probe should be adjusted

    4. D.

      This site is suitable for cannulation

  2. 2.

    While attempting peripheral venous access, the following image is obtained. There is no return of blood in the catheter. What is the next best step?

    1. A.

      Withdraw the needle and advance again

    2. B.

      Advance the needle further into the vessel

    3. C.

      Rotate the probe to obtain a long-axis view

    4. D.

      Agitate the needle to confirm visualization

  3. 3.

    Which of the following statements is most accurate?

    1. A.

      Subclavian catheters have a lower infectious risk, but higher thrombotic risk than femoral catheters.

    2. B.

      Internal jugular catheters have the lowest risk for infection.

    3. C.

      Ultrasound cannot be used for guidance for subclavian cannulation.

    4. D.

      Femoral catheters have the highest risk for both thrombosis and infection.

  4. 4.

    Which of the following statements regarding pulmonary arterial catheter (PAC) placement is most true?

    1. A.

      A midesophageal ascending aorta SAX view can confirm appropriate catheter position.

    2. B.

      A midesophageal RV inflow-outflow view can confirm appropriate catheter position.

    3. C.

      Ultrasound decreases time to placement and the success rate of PACs.

    4. D.

      A midesophageal modified bicaval tricuspid valve view can confirm appropriate catheter position.

  5. 5.

    Which of the following sites would be most appropriate for insertion of a LEFT femoral venous catheter in the following image?

    1. A.

      A

    2. B.

      B

    3. C.

      C or D

    4. D.

      None of the above

figure 19
figure 20
figure 21

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Herway, S.T., Cronin, B. (2022). Ultrasound for Vascular Access. In: Maus, T.M., Tainter, C.R. (eds) Essential Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-030-84349-6_23

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-84349-6_23

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-84348-9

  • Online ISBN: 978-3-030-84349-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation