Principles of Vascular Access

Abstract

Vascular access procedures are commonly performed by acute care physicians within a wide myriad of clinically settings such as the operating room (OR), emergency department (ED), or intensive care unit (ICU) for a wide variety of indications. Regardless of location or indication, vascular access procedures are not innocuous and procedural success traditionally has relied on knowledge of anatomy and familiarity of the procedure. In a prospective study by Schummer et al. (Intensive Care Med 33(6):1055–1059, 2007) that included 1794 cases using landmark techniques, there was a 3.3 % complication rate with vascular catheterization. Also, as the number of passes with the entry needle increases so does the rate of mechanical complication whereby three or more needle passes incurs a six-fold increase in complication rate (Hall and Russell, Anaesthesia 60(1):1–4, 2005). Furthermore, certain subgroups such as children and obese patients have been further identified as having increased risk with vascular access. Although the reported complication rates are relatively low, considering the number of vascular access procedures performed annually as the denominator, the absolute number of complication occurrences becomes significant. Improved assessment of vascular anatomy and visualization during the procedure in an effort to mitigate complications and improve procedural success form the argument supporting ultrasound (US) guided vascular access.