Ultrasound guidance for peripheral venous access.

To the Editor:—I read the letter by Dr. Stone with keen interest. I have three concerns about the technique the author describes. First, the author defines two attempts as a criterion for labeling difficult venous access, which may not be true. This is subjective, because the procedure may be performed by junior staff or there may be a bias effect because the operator knows that if two attempts fail, an ultrasound-guided technique will be used. Therefore, I question the validity of this study. Second, a spring wire guide/catheter over needle assembly, used for arterial catheterization in place of ordinary venous catheterization, is expensive. An ordinary venous catheter is much less expensive as compared with a venous catheter along with an arterial catheterization set. In extreme cases, it may be acceptable to waste one arterial line set, but it may not be a good economical, evidence-based technique. Third, for this technique you need another person for assistance, which is not usually available in the day surgery theater. Therefore, the technique would not be very practical in difficult venous access management. I think the author did not test the technique in just the population in which it could be useful: those with recognized difficult venous access. Until the technique is tested in that population, I do not think it will gain acceptance in our anesthetic practice.