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

Guidelines for Ultrasound-guided Central Venous Catheter Placement

Various recommendations and guidelines with different clinical scopes and for different target audiences have been published during the last years.

In 2012, a joint guideline from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists[15] strongly recommended the use of real-time US for CVC placement in the IJV (category A, level 1 evidence), while it was not recommended for the SV (category A, level 3 evidence). For the FV, no recommendation for routine use of US was made because of insufficient scientific evidence (category C, level 2 evidence).

A practice guideline from the American Society of Anesthesiologists task force, also in 2012,[25] recommended the use of static US imaging in elective situations for prepuncture identification of the anatomy and to evaluate the vessel localization and patency and real-time US for venipuncture for the IJV. Further, it is recommended that both static and real-time US "may" be used for CVC placement in the SV or FV.[25]

For CVC placement in critically ill patients treated in the intensive care unit, an international expert panel recommended in 2012 the routine use of US for short-term and long-term central venous access in adults.[13] More specifically, the panel recommended the utilization of 2D US imaging with a long-axis/in-plane technique for vascular access[13] and agreed on the very strong recommendation (based on Level A evidence) that "US-guided vascular access has to be used because it results in clinical benefits and reduced overall costs of care makes it cost-effective".[13]

The guidelines for the appropriate use of bedside general and cardiac US from the American College of Critical Care Medicine[26] give a strong (1-A) recommendation for the general use of US for central venous access in real-time technique (1-B) using a short-axis approach (1-B). Regarding the site for CVC placement, the guidelines give a strong (1-A) recommendation for the IJV and the FV, but a conditional recommendation (2-C) for the SV.[26]

A guideline from the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB)[9] also recommends pre-interventional US vessel screening of target vessels to determine the most appropriate anatomical site and the optimal patient position (5-D) and routine real-time US guidance during CVC placement (1-A).[9]

In 2016, the Association of Anaesthetists of Great Britain and Ireland[27] also recommended the routine use of US for CVC placement in the IJV. In addition, the expert group recommends US use "for all other central venous access sites, but recognizes evidence is, at present, limited".[27] Nevertheless, the recommendation also underlines that the understanding of the landmark technique is necessary for situations when US is not available.