Ultrasound guidance should be the standard of care for most invasive procedures performed by clinicians

In this issue of the journal Rudas publishes a review describing the utility and efficacy of ultrasound when used to guide the performance of percutaneous tracheostomy placement. An Australasian Society for Ultrasound in Medicine (ASUM) grant funded research completed by the same authors, and presented at the recent 2012 ASUM meeting in Sydney. This demonstrated that ultrasound improves first-pass success rate and improves accuracy when compared to the landmark technique in performing percutaneous tracheostomy. This is not a surprising finding given the plethora of recent literature supporting the use of ultrasound by clinicians to guide a wide variety of procedures previously done “blindly”. In many areas advantages have been demonstrated in patient safety, time taken for the procedure, as well as in cost savings. Fortunately for our patients, the days of blindly performed procedures, using traditional anatomical landmarks are numbered. Imagine the outcry if an amniocentesis were performed without ultrasound guidance. The same standard should be set for all invasive procedures where ultrasound guidance is practical, and there is risk if the desired target is not hit and adjacent structures are damaged. This does not mean that the widespread use of ultrasound for procedural guidance is without difficulty. Acquiring the necessary cognitive and psychomotor skills to perform ultrasound-guided procedures takes time and practice. There remains controversy over the exact amount of training required, and how to ensure competence. In addition using ultrasound, even in competent hands, does not completely eliminate complications. Radiologists have used ultrasound to guide procedures for years, including most of those listed in Table 1 (this list is not exhaustive). Many of these procedures will remain within the domain of the imaging specialist quite appropriately. In recent years however, particularly in the emergency setting, clinicians are increasingly performing their own specialty-specific ultrasound-guided procedures. In addition to this, advanced nurse practitioners (such as those dedicated to the PICC line service in many hospitals) are also developing these skills.