Ultrasound Guided Vascular Access
Ultrasound Guided Vascular Access Placement-IntroductionThis will be the first of several posts on ultrasound guided vascular access. We will drill down to detailed techniques in future posts.
Vascular cannulation is an important aspect of clinical practice for anesthesiologists. Landmark techniques relied on surface anatomy identification and palpation with a success rate of only 60-95% and a complication rate of 5-19%(1).
Ultrasound guidance before and during vascular cannulation to reduce complications and improve first pass access has been recommended by multiple societies and government agencies including American Society of Echocardiography(2).
Real time ultrasound guidance using sterile technique is the most effective method for vascular access placement. Short axis, long axis and oblique axis views have been developed to guide needle entrance into the desired blood vessel. Manual compression, color flow Doppler and pulse wave Doppler could help to identify vein, artery and other surrounding structures.
It is recommended that properly trained clinicians use real-time ultrasound during internal jugular vein cannulation whenever possible to improve cannulation success and reduce the incidence of complications in both adult and pediatric patients. High-risk patients may benefit from ultrasound screening of the subclavian vein before attempted cannulation to identify vessel location and patency and to specifically identify thrombus before attempted cannulation. Real-time ultrasound should be used whenever possible for femoral vein cannulation in pediatric patients but only for examining to identify vessel overlap and patency when feasible in adults2.
For radial artery cannulation, there is evidence to support for the use of ultrasound to improve first-pass success(3). Ultrasound is most effectively used to identify the location and patency of suitable veins for peripherally inserted central venous catheters(2).
With proper training, clinicians can realize the clinical outcomes supported by the literature, to gain an appreciation of the ultrasound anatomy, identify the optimal entry site and needle angle, and understand the limitations of the ultrasound-guided technique(2).
1. McGee DC, Gould MK. Preventing complications of central venous cath- eterization. N Engl J Med 2003;348:1123-33.
2. Troianos, Christopher A., et al. "Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists." Journal of the American Society of Echocardiography 24.12 (2011): 1291-1318.
3. Shiloh AL, Savel RH, Paulin LM, Eisen LA. Ultrasound-guided catheteriza- tion of the radial artery: a systematic review and meta-analysis of random- ized controlled trials. Chest 2011;139:524-9. Ultrasound guidance has been widely used in nerve block. Ultrasound guidance can also be applied for vascular cannulation. By doing so, we can not only increase the utilization of ultrasound machine, but also improve the clinical outcomes. 欢迎全英文讨论交流，也欢迎大家对该文进行翻译 We will post step by step ultrasound guided vascular access. Thanks
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