RT Book, Section
A1 Reichman, Eric F.
SR Print(0)
ID 57705209
T1 Chapter 50. Ultrasound-Guided Vascular Access
T2 Emergency Medicine Procedures, 2e
YR 2013
FD 2013
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-161352-1
LK accessemergencymedicine.mhmedical.com/content.aspx?aid=57705209
RD 2024/04/18
AB Central  venous  catheterization  is  essential  in  the  management  of  critically  ill  patients  seen  in  the  Emergency  Department  (ED).  It  allows  for  fluid  resuscitation,  central  venous  pressure  monitoring,  pacemaker  placement,  and  administration  of  vasoactive  medications.  Complications  such  as  arterial  puncture,  hematoma,  pneumothorax,  hemothorax,  and  air  embolus  have  been  reported  to  occur  in  5%  to  20%  of  patients.1–3  Unsuccessful  cannulation  has  been  reported  in  up  to  20%  of  cases.4,5  Central  venous  catheterization  has  traditionally  been  performed  using  surface  anatomic  landmarks  as  a  guide  to  locate  the  veins.  Catheterization  is  not  always  successful  using  the  landmark  method  due  to  anatomical  variations  or  obscured  landmarks.  Other  factors  such  as  obesity,  shock,  dehydration,  intravenous  drug  abuse,  congenital  deformities,  thromboses,  and  scarring  can  complicate  the  procedure.  Ultrasound  (US)-guided  vascular  access  is  widely  supported  in  current  medical  practice.  The  use  of  US  guidance  for  central  venous  cannulation  has  been  endorsed  by  several  medical  societies  and  supported  by  numerous  trials  in  the  literature.  US  guidance  has  been  shown  to  improve  cannulation  success  rates,  reduces  mean  insertion  attempts,  and  reduce  placement  failure  rates.6–11  US  guidance  allows  the  Emergency  Physician  to  more  precisely  locate  target  vessels  and  also  provide  real  time  visualization  of  needle  placement.