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What’s New in the
Patient Safety World
March 2025
Guidelines for
Ultrasound-Guided Vascular Cannulation
The American Society
of Echocardiography (ASE) has updated its guidelines for ultrasound-guided vascular
cannulation. The new
guidelines replace the 2011 guidelines and include recommendations for
US-guided access to central and peripheral veins and arteries in adult and
pediatric patients based on the strength of the scientific evidence
present in the
literature.
Ultrasound can not
only identify anatomy and suitable vessel size for cannulation
but it can also:
·
Determine
vessel patency
·
Real-time
US guidance during needle insertion and catheter advancement
·
Confirm
guidewire position in a vessel
·
Assess
for complications
The document nicely
describes the evidence and strength of evidence for ultrasound guidance for a
variety of specific veins and arteries, with both excellent photographs and
diagrams to illustrate techniques.
The choice of vessel
puncture site is based on the clinical scenario, indication for vascular
access, patient comfort and condition, operator experience, ease of access, and
vessel characteristics
Examples of specific
vessels and procedures discussed are the internal jugular vein, subclavian and
axillary veins, common femoral vein, peripheral veins, peripherally inserted
central catheters (PICC’s), radial and ulnar arteries, brachial artery, axillary
artery, common femoral artery, posterior tibial and dorsalis pedis arteries.
For instance, the
section on the internal jugular vein (IJV) begins with a description of the
anatomy, including variable relationship with the carotid artery (CA). Then it
goes on to describe how the patient should be positioned and what anatomical
landmarks should be visualized. In the US-guided technique, the operator scans
the IJV to determine the puncture site that provides a direct pathway to the
vessel lumen and minimizes IJV-CA overlap and the risk for CA puncture.
It has a good
section on common complications, such as hematoma, abscess, seroma, lymphocele,
thrombosis, embolization, stenosis, vasospasm, arterial dissection,
pseudoaneurysm, arteriovenous fistula, and several site-specific complications.
It also has an
extensive section on pediatric vascular access.
References:
American Society of Echocardiography (ASE). Guidelines for Performing Ultrasound-Guided Vascular Cannulation: Recommendations of the American Society of Echocardiography. ASE February 2025
https://www.asecho.org/wp-content/uploads/2025/02/PIIS0894731724006321_VascCann_Feb25.pdf
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