European Society of Anaesthesiology guidelines on peri-operative use of ultrasound-guided for vascular access (PERSEUS vascular access)

Abstract

Ultrasound for diagnostic and procedural purposes is becoming a standard in daily clinical practice including anaesthesiology and peri-operative medicine. The project of European Society of Anaesthesiology (ESA) Task Force for the development of clinical guidelines on the PERioperative uSE of Ultra-Sound (PERSEUS) project has focused on the use of ultrasound in two areas that account for the majority of procedures performed routinely in the operating room: vascular access and regional anaesthesia. Given the extensive literature available in these two areas, this paper will focus on the use of ultrasound-guidance for vascular access. A second part will be dedicated to peripheral nerve/neuraxial blocks. The Taskforce identified three main domains of application in ultrasound-guided vascular cannulation: adults, children and training. The literature search were performed by a professional librarian from the Cochrane Anaesthesia and Critical and Emergency Care Group in collaboration with the ESA Taskforce. The Grading of Recommendation Assessment (GRADE) system for assessing levels of evidence and grade of recommendations were used. For the use of ultrasound-guided cannulation of the internal jugular vein, femoral vein and arterial access, the level evidence was classified 1B. For other accesses, the evidence remains limited. For training in ultrasound guidance, there were no studies. The importance of proper training for achieving competency and full proficiency before performing any ultrasound-guided vascular procedure must be emphasised.

Effects of ipsilateral tilt position on the cross-sectional area of the subclavian vein and the clinical performance of subclavian vein catheterization: a prospective randomized trial

“…Ultrasonographic assessment can be applied before, during, and after central venous cannulation, and provides clinicians with advantages of success, speed, and safety, by visualizing vessel viability, size, and patency, as well as the location of other adjacent anatomically important structures [12,33]. With respect to ultrasound-guided subclavian vein catheterization, although the quality of evidence is generally weak, the use of ultrasound-guidance is recommended in adult patients [9]. The results of the present study also provide supplemental evidence for the current guidelines.…”

“…Although ultrasonography is widely used during vascular access in most medical facilities, and is recommended as a standard method during central venous catheterization by a number of professional organizations [ 9 – 11 ], a traditional landmark-based technique is still important and useful in certain clinical situation where the ultrasonography is not promptly available or when the operator is not familiar with the equipment. For anatomical landmark-based technique, although it is still uncertain how much increase in the cross-sectional area of the vein will affect the success of catheter placement, the cross-sectional area of the vein can theoretically have an impact on the success rate of venous catheterization by affecting the venipuncture success rate [ 12 ].…”

Rapid Femoral Vein Assessment (RaFeVA): A systematic protocol for ultrasound evaluation of the veins of the lower limb, so to optimize the insertion of femorally inserted central catheters

“…32,33 Several studies show that US guidance significantly reduces early mechanical complications, late infectious and thrombotic complications, the number of attempts and the costs not only for PICC and CICC, but also during FICC insertion. 1,34 In a recent guideline, a panel of experts have suggested that the benefits of US guidance documented in other studies for CFV might be extended to venous access to SFV. 1 This is very interesting from the clinical point of view, since the exit site of a non-tunneled FICC inserted in the SFV is located at mid-thigh, that is, far from the inguinal fold, in a clean, flat and stable area where dressings can be managed optimally, reducing the risk of infection and thrombosis.…”

“…1,34 In a recent guideline, a panel of experts have suggested that the benefits of US guidance documented in other studies for CFV might be extended to venous access to SFV. 1 This is very interesting from the clinical point of view, since the exit site of a non-tunneled FICC inserted in the SFV is located at mid-thigh, that is, far from the inguinal fold, in a clean, flat and stable area where dressings can be managed optimally, reducing the risk of infection and thrombosis.…”

“…In this technical note we will focus on the importance of the preliminary US-based venous assessment, a strategy that allows to evaluate the state of the veins, the anatomical alterations or the presence of pathological conditions as well as to identify the relationship of the vein with the surrounding structures in order to choose the vein suitable for cannulation and to minimize complications related to the cannulation procedure and late complications related to the presence of the catheter. [1][2][3][4][5]7,10,[15][16][17][26][27][28] Central venous access devices in children and adults are currently classified as centrally inserted central catheters (CICC), peripherally inserted central catheters (PICC) and femorally inserted central catheters (FICC). Systemic and standardized approaches for the preliminary ultrasound evaluation before CICC and PICC insertion have already been developed.…”