Ultrasound-Guided Cannulation

Ultrasound-guided cannulation of veins and arteries has become the gold standard technique in critically ill patients. The internal jugular vein was the first site at which landmark-based and ultrasound techniques were compared; the results showed that the latter was associated with higher overall and first-attempt success rates and complication rates for both experienced and inexperienced operators. Given the high level of evidence, all medical societies and expert panels now recommend cannulating the internal jugular vein with ultrasound guidance. Many other studies have assessed ultrasound-guided cannulation for other vessels (including the femoral, subclavian, and peripheral veins and the radial and femoral arteries) in adult and pediatric patients. Almost all these studies demonstrated that ultrasound is very useful in decreasing the time to success, increasing the success rate, and decreasing the complication rate, although levels of evidence are lower for some vessels than for the internal jugular vein. Oblique, short-axis, and long-axis views have all been used to monitor vessel puncture and offer similar levels of cannulation accuracy. The patient’s level of comfort is much higher when ultrasound-guided techniques are applied. The challenge now is to train all residents in this technique, so training programs should be available in all hospitals.