Anestesia e Pesquisa Clínica
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The Use of Ultrasound for Central Venous Access: are we Becoming Complacent?

Laura Beard and Max Hodges

Ultrasound use for the placement of central venous catheters has become part of routine practice and is advocated by many governing bodies. The use of real time ultrasound has been shown to improve first pass success rate and reduce the risk of complications such as arterial trauma. Complications arising from inadvertent carotid dilation/cannulation include haemorrhage, pseudo aneurysm, AV fistula formation, arterial dissection, neurological injury including stroke and lethal airway obstruction secondary to haematoma formation. The use of ultrasound has reduced but not fully eliminated the risk of inadvertent arterial dilation/cannulation. This is often due to operator inexperience and/or the incorrect use of ultrasound. The consequences of inadvertent arterial dilation/cannulation to the patient can be life threatening and it is important that we do not become complacent when inserting central lines under ultrasound guidance or when supervising others using ultrasound. Additional checks such as pressure transducing the needle or performing blood gas analysis on the aspirate prior to dilation should not be forgotten when there is concern about needle placement.