Postgraduate educational pictorial review: Ultrasound-guided vascular access

Abstract

Over the last few years the role of ultrasound has steadily increased and has now an established role in anesthesia and critical care. The various applications of this technology in this field include ultrasound-guided insertion of central lines (internal jugular, subclavian, axillary, femoral) and peripheral venous catheters, arterial line insertion, regional blocks etc. The simple reason of using this technology is “You believe what you see”. In this text we will mainly focus on central line, peripheral venous placement and arterial blood flow patterns under ultrasound guidance.In our institution at KFMC, internal jugular vein cannulation is preferred to cannulation of the subclavian vein because of the higher incidence of pneumothorax and subclavian artery puncture associated with the later. The incidence of carotid artery puncture is higher in children younger than five years than in older children during this procedure. The use of ultrasonography has been shown to increase the success rate and decrease the incidence of complications associated with IJV cannulation in adults.We will go through a stepwise approach in identifying and confirming the required blood vessels for ultrasound-guided cannulation using B-mode (2D), color flow doppler and Pulse Wave Doppler

Comparison of ultrasound guided brachiocephalic and internal jugular vein cannulation in critically ill children

“…A large randomized clinical trial is warranted to confirm our results. A C C E P T E D M A N U S C R I P T CVC indwelling days 8,5 (6-12) IQR [6][7][8][9][10]7] …”

Performing central venous catheters in neonates and small infants undergoing cardiac surgery using a wireless transducer for ultrasound guidance: a prospective, observational pilot study

“…The most frequent complications of central venous catheterization are arterial or hematoma formation, making further attempts more difficult and leading to high failure rates. Furthermore, the incidence of carotid artery puncture is known to be even higher in children younger than 5 years [18]. In this observational study, the incidence of carotid artery puncture was 0%, which in the author's opinion is clearly related to the US guidance allowing for the good visualization and clear distinction of the patients' arteries and veins.…”

Acceso vascular guiado por ecografía en el niño crítico: ventajas, retos y nuevas técnicas = Ultrasound guided vascular access in critically ill children: Advantages, challenges and new techniques

“…Por ello es muy importante mantener la dirección de la aguja siempre alineada con el plano del haz de ultrasonidos. (81,82) Figura 1.30 (30): Abordaje longitudinal en plano. La vena se "corta" en longitudinal (a), y la aguja se introduce en plano observándose en toda su longitud (c).…”