Author: Russell McLoughlin / Editor: John P Sloan / Reviewer: Martin Dore, Michael Perry, Nishant Cherian / Codes: / Published: 21/06/2023
Vascular access is a common procedure in the emergency department (ED). Using ultrasound to visualise vessels is helpful, but the additional skill of using ultrasound to guide the procedure is even more so. Central, femoral and basilic vein cannulations are described, together with key aspects of imaging technique.
Prerequisites
- Ultrasound: Indications
- Ultrasound: Physics and Basic Equipment Settings
- Ultrasound: Image Acquisition
- Ultrasound: FAST
- Ultrasound : AAA
After completing this session you will be able to:
- Explain the indications for jugular, femoral and peripheral cannulation
- Identify which probe to use and how to adjust the machine
- Describe how to position the patient
- Demonstrate the neck, groin and antecubital fossa appearances
- Review the key techniques for safe cannulation
References:
- Keenan SP. Use of ultrasound to place central lines. Journal of Critical Care, 2002;17(2):126137.
- Leung J, Duffy M, Finckh A. Real-time ultrasonographically-guided internal jugular vein catheterization in the emergency department increases success rates and reduces complications: A randomized, prospective study. Annals of Emergency Medicine 2006;48(5):540-547.
- National Institute for Clinical Excellence. Guidance on the use of ultrasound locating devices for placing central venous catheters. London: NICE, [NICE Technology Appraisal No 49], 2002.
- Royal College of Medicine UK. RCEM – Specialised Skills – Ultrasound Training.
- Atkinson P, Boyle A, Robinson S. et al. Should ultrasound guidance be used for central venous catheterisation in the emergency department? Emergency Medicine Journal 2005 (Mar);22:158164.
- Sefidbakht S, Assadsangabi R, et al. Sonographic measurement of the inferior vena cava as a predictor of shock in trauma patients. Emergency Radiology 2007;14(3):181-185.
- Teichgraber UK, Nibbe L, Gebauer B. et al. Inadvertent puncture of the thoracic duct during attempted central venous catheter placement . Cardiovasc Intervent Radiol 2003 (Nov-Dec);26(6):569-571.
- Levy JA, Bachur RG. Bedside ultrasound in the pediatric emergency department. Current Opinion in Pediatrics, 2008;20(3):235-242.
- Skippen P. Kissoon N. Ultrasound guidance for central vascular access in the pediatric emergency department. Pediatric Emergency Care, 2007;23(3):203-207.
- Clenaghan S, McLaughlin RE, Martyn C et al. Relationship between Trendelenburg tilt and internal jugular vein diameter. Emergency Medicine Journal, 2005;22(12):867-868.
- Hilty WM, Hudson PA, Levitt MA et al. Real-time ultrasound-guided femoral vein catheterization during cardiopulmonary resuscitation. Annals of Emergency Medicine, 1997;29:331336.
- Wang R, Snoey ER, Clements RC et al., Effect of head rotation on vascular anatomy of the neck: an ultrasound study. Journal of Emergency Medicine, 2006;31(3):283-286.
- Blackshaw R, Peat W, Youngs P. Use of ultrasound to obtain peripheral venous access. International Journal of Obstetric Anesthesia, 2006;15(2):174-175.
- Milling T, Holden C, Melniker L et al., Randomized controlled trial of single-operator vs. two-operator ultrasound guidance for internal jugular central venous cannulation. Academic Emergency Medicine, 2006;13(3):245-247.
Thanks are offered to the following people for their assistance with this session.
- Dr Rhodri Evans, Consultant Radiologist, Swansea
- Gekko Graphics