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

Technical Developments in the Field of Ultrasound-guided Vascular Access

Needle guides are devices placed on the US transducer that might improve the cannulation success by facilitating aligning the angle between the US and the needle plane so that the two planes intersect at the depth of the vessel selected for cannulation.[40] Especially for inexperienced users,[41] the needle guides help to guide the needle along the path of the US beam at the correct angle and distance depending on the depth of the targeted structure. Needle guides facilitate faster cannulation for IJV CVCs (only for inexperienced operators)[42] and SV CVCs.[40] Nevertheless, in a simulation model study, a needle guide used in a long-axis vessel approach improved needle visualization but did not improve puncture of the target vessel compared with a free-hand technique.[43] Altogether, based on the contradicting evidence,[43,44] no rigorous conclusion about the clinical value of needle guide devices can currently be drawn.

Different real-time 3D techniques (sometimes referred to as 4D US with time being the fourth dimension) for US-guided CVC placement have been described.[45,46] Lower image resolution, larger US probe dimensions, and artifacts making needle visualization difficult, however, are still major limitations of this innovative concept.[46]

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