Ultrasound-guided vascular access in critical illness
Over the past two decades, ultrasound (US) has become widely accepted to guide safe and accurate insertion of vascular devices in critically ill patients. We emphasize central venous catheter insertion, given its broad application in critically ill patients, but also review the use of US for accessing peripheral veins, arteries, the medullary canal, and vessels for institution of extracorporeal life support. To ensure procedural safety and high cannulation success rates we recommend using a systematic protocolized approach for US-guided vascular access in elective clinical situations. A standardized approach minimizes variability in clinical practice, provides a framework for education and training, facilitates implementation, and enables quality analysis. This review will address the state of US-guided vascular access, including current practice and future directions.
KeywordsCentral venous catheter Vascular access Ultrasound Education Complications
Compliance with ethical standards
Conflicts of interest
Dr. Blaivas consults for and receives consulting fees from EchoNous, Inc. Dr. Lamperti is a scientific advisor of MEDTRONIC, received travel support from Fesenius Kabi and VYGON and honoraria from Draeger, Masimo, and MEDTRONIC. None of these relationships presents conflicts with regards to the content of this manuscript.
An approval by an ethics committee was not applicable.
Supplementary material 6 (MP4 4897 kb) PIV insertion using a long-axis, in-plane approach using a manikin trainer
Supplementary material 7 (MP4 4898 kb) PIV insertion using a long-axis, in-plane approach and modified Seldinger technique with wire insertion using a manikin trainer
Supplementary material 8 (MP4 54,261 kb) Operator inserting IO into himself: Here a clinician is placing an IO into his own tibia using a commercially available drill. Pain is minimal and the procedure can be performed rapidly. The operator confirms proper placement with aspiration and flush. (Courtesy Mark Piehl, MD)
Supplementary material 9 (MP4 1032 kb) IO failure with flow above cortex: blood flow is seen on color Doppler above the bony cortex in this failed IO placement
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