9 Ultrasound Guided Vascular Access

Vascular access is an important procedure for clinicians to master. Chronic medical conditions, intravenous drug use, and obesity can all make placements of vascular catheters in central and peripheral veins challenging and time-consuming. External landmarks have traditionally guided the placement of the needle for the performance of central venous catheterization. The proximity of such structures as the large arteries of the chest and neck as well as the apex of the lung results in a 6.2-11.3% rate of immediate mechanical complications when performing subclavian or internal jugular catheterization.1 In recent years there have been significant improvements in portable ultrasound technology including the development of relatively inexpensive ultrasound machines with sufficient resolution to guide needle placement through tissues. These machines are now found throughout the house of medicine by the bedside of patients. Multiple studies have been performed demonstrating the benefits of ultrasound guidance of central venous catheter placement by multiple specialties, and the same technique has been extended to the placement of peripheral intravenous catheters.2,3,4,5,6 In this chapter, we describe the use of ultrasound for guidance of vascular access.