Ultrasound-Guided Central Venous Catheter Placement

A Structured Review and Recommendations for Clinical Practice

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

Disclosures

Crit Care. 2017;21(225) 

In This Article

Use of Ultrasound for Central Venous Catheter Placement in Clinical Practice

Several survey studies evaluated the attitudes and beliefs of intensivists and anesthesiologists on the use of US for CVC placement and the frequency of its use in clinical practice.

In 2008, McGrattan et al.[28] performed a survey among 2000 senior anesthesiologists in the United Kingdom and revealed that only 27% of these stated using US as the first-choice approach for CVC placement in the IJV (50% used the surface landmark technique and 30% palpation of the carotid artery as first-choice approaches).

Among emergency physicians in the United States, 44% stated in 2014 that they never use US to guide CVC placement.[10] On the other hand, 20% and 9% of respondents stated using US in at least 90% and 100% of cases, respectively.

A survey among 784 intensivists in the United States performed in 2016[29] revealed a moderate to very frequent use of US depending on the site for CVC placement ranging from 31% for the SV to 80% for the IJV (45% for the FV). Barriers to the use of US reported by these respondents were limited availability of US equipment (28%), perception of increased time for US-guided CVC insertion (22%), and concerns about losing skills for the landmark technique (13%).[29]

Among 190 French intensivists, a practice survey[30] reported high rates of US use for CVC placement in 2016, with 18% and 50% of physicians always or almost always, respectively, using an US-guided CVC technique (6% never, 10% almost never, 17% half of the time). Interestingly, a higher proportion of residents compared with senior doctors stated always or at least almost always using US.

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