Deep Needle Procedures: Improving Safety With Ultrasound Visualization

Abstract

Promoting patient safety and increasing health care quality have dominated the health care landscape during the last 15 years. Health care regulators and payers are now tying patient safety outcomes and best practices to hospital reimbursement. Many health care leaders are searching for new technologies that not only make health care for patients safer but also reduce overall health care costs. New advances in ultrasonography have made this technology available to health care providers at the patient's bedside. Point-of-care ultrasound assistance now aids providers with real-time diagnosis and with visualization for procedural guidance. This is especially true for common deep needle procedures such as central venous catheter insertion, thoracentesis, and paracentesis.There is now mounting evidence that clinician-performed point-of-care ultrasound improves patient safety, enhances health care quality, and reduces health care cost for deep needle procedures. Furthermore, the miniaturization, ease of use, and the evolving affordability of ultrasound have now made this technology widely available. The adoption of point-of-care ultrasonography has reached a tipping point and should be seriously considered the safety standard for all hospital-based deep needle procedures.

FIGURE 1

Ultrasound-guided CVC insertion. A, A clinical provider performing real-time ultrasound guidance using a high-frequency linear transducer (13-6 MHz) during the insertion of a right internal jugular CVC with the patient in Trendelenburg. B, Transverse view of the right internal jugular vein and the right carotid artery. The clinician can confirm venous puncture using ultrasound, avoiding arterial puncture and iatrogenic pneumothorax.

FIGURE 2

Ultrasound-guided thoracentesis. A, A clinician performing real-time ultrasound guidance using a phased array transducer (5-2 MHz) during a thoracentesis with the patient in seated position. B, Ultrasound view of target for thoracentesis. The clinician can safely sample loculated fluid for analysis, with a large decrease in rate of iatrogenic pneumothorax.

FIGURE 3

Ultrasound-guided paracentesis. A, A clinician performing bedside ultrasound guidance using an abdominal transducer (5-1 MHz) during a paracentesis, with the patient in supine position and the head of bed at 30 degrees. B, Ultrasound view of ascitic fluid. The clinician can safely identify the target for paracentesis, reducing intraperitoneal hemorrhage and bowel perforation.