Ultrasound-Guided Central Venous Catheter Placement

A Structured Review and Recommendations for Clinical Practice

Bernd Saugel; Thomas W. L. Scheeren; Jean-Louis Teboul


Crit Care. 2017;21(225) 

In This Article

Rationale for Ultrasound-guided Central Venous Catheter Placement

Traditionally, CVC placement is performed using landmark techniques based on the knowledge of anatomic structures and palpation of arteries next to the veins. These landmark techniques cannot account for anatomic variations at the CVC insertion site. Anatomic variations to the "normal anatomy", however, have been described in a relevant proportion of patients for the internal jugular vein (IJV), the subclavian vein (SV), and the femoral vein (FV).[3,4,5,6,7,8,9,10,11] In addition to anatomic variations, venous thrombosis that is especially common in oncologic and critically ill patients can make CVC placement impossible or dangerous for the patient.[9]

The described anatomic variations and the presence of venous thrombosis can hardly be identified using a landmark technique. In contrast, US can be used to easily visualize anatomic structures and confirm patency of the vein and thus help to avoid unintended arterial puncture or unsuccessful cannulation. In addition, US can facilitate CVC placement in special clinical situations in which landmark techniques based on palpation of the arterial pulse are challenging or impossible (e.g., femoral CVC placement during cardiopulmonary resuscitation[12] or in patients with a nonpulsatile ventricular assist device).