Principles of ultrasound-guided venous access
- Erica Mitchell, MD, FACS
Erica Mitchell, MD, FACS
- Professor of Surgery
- Division of Vascular Surgery
- Oregon Health & Science University
- Jeremiah J Sabado, MD
Jeremiah J Sabado, MD
- Clinical Instructor of Radiology and Pediatrics
- Sidney Kimmel Medical College of Thomas Jefferson University
- Section Editors
- David L Cull, MD
David L Cull, MD
- Section Editor — Arterial and Venous Access
- Clinical Professor, Department of Surgery
- University of South Carolina School of Medicine
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
Establishing venous access is critically important and is sometimes technically challenging. Among the many indications for bedside ultrasound, ultrasound-guided venous catheter placement is well described and increasingly used [1,2].
The principles of ultrasound-guided venous access will be reviewed here. General considerations and techniques for central venous access at specific sites are discussed separately. (See "Overview of central venous access" and "Vascular (venous) access for pediatric resuscitation and other pediatric emergencies" and "Placement of femoral venous catheters" and "Placement of subclavian venous catheters" and "Placement of jugular venous catheters".)
Randomized trials and observational studies in children and adults have found that real-time ultrasound imaging during needle placement reduces time to venous cannulation and reduces the risk of complications during central venous and peripheral venous access [3-9]. The level of benefit varies depending upon operator skill and the anatomic site.
Ultrasound-guided venous access is indicated in any patient for whom central vascular access via the internal jugular vein or femoral vein is necessary when equipment and operator expertise is available [5,10]. Static vein localization and/or dynamic ultrasound guidance is also helpful for identifying or confirming a patent vein site prior to central vein catheter or peripherally-inserted central catheter (PICC) placement, or for establishing peripheral intravenous access in adults and children when difficulty is expected or when the traditional blind technique has failed [11,12].
Central venous access — Based upon randomized trials, we recommend that when equipment and expertise are available, children and adults undergoing central venous access at internal jugular or femoral access sites have the procedure guided by dynamic ultrasound rather than using the landmark technique alone [5,6,13-15]. Ultrasound is also commonly used to place peripherally-inserted central catheters (PICC) via the brachial or basilic vein in adults, children, and sedated neonates [16-18].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Central venous access
- - Internal jugular vein
- - Femoral vein
- - Subclavian vein
- Peripheral intravenous access
- - Use in children
- Intraosseous access
- CONTRAINDICATIONS AND PRECAUTIONS
- ULTRASOUND EQUIPMENT
- ULTRASOUND ANATOMY
- Probe orientation
- - Transverse (short axis) view
- - Longitudinal (long axis) view
- PATIENT PREPARATION
- ULTRASOUND MACHINE PREPARATION
- ULTRASOUND-GUIDED TECHNIQUES
- Dynamic ultrasound to guide vein cannulation
- PITFALLS AND COMPLICATIONS
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS