Ultrasound Guidance for Central Venous Catheter Placement

tive technique for the percutaneous insertion of large-bore catheters into blood vessels that allowed for the application of angiocatheters for angiography. The Seldinger technique for central venous catheter (CVC) placement is ubiquitous in medical practice and the procedure is well known. Briefly, the procedure involves introducing a percutaneous needle into the vessel, passing a guidewire through the needle, and then placing the catheter over the guidewire and inserting it into the blood vessel. In addition to revolutionizing the fields of cardiology and interventional radiology, this technique has had a profound impact through its contribution to the development of central venous infusion catheters.1 CVC placement is common in the United States, with an estimated several million catheters placed annually.2 Data from the European Prevalence of Infection in Intensive Care study, which included 10,038 patient case reports, showed that 78% of critically ill patients had a CVC placed.3 Traditionally, the site of initial needle insertion during CVC placement is determined by using palpable or visible anatomic structures with known relationships to the desired vein as landmarks.1 However, ultrasound is increasingly being used to identify vessels and guide needle insertion for CVC placement. Real-time ultrasoundguided CVC placement is employed by a variety of medical specialties, and there is ample support for its use in the medical literature.4–10 This review discusses the practice and techniques of real-time ultrasound guidance for CVC insertion.