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. 2021 Nov;22(1_suppl):97-105.
doi: 10.1177/11297298211019494. Epub 2021 Jul 19.

Ultrasound in central venous access for hemodialysis

Giacomo Forneris  1 , Antonio Marciello  2 , Daniele Savio  3 , Maurizio Gallieni  4   5
Affiliations

Ultrasound in central venous access for hemodialysis

Giacomo Forneris et al. J Vasc Access. 2021 Nov.

Abstract

Central venous cannulation is a frequent need for urgent or scheduled hemodialysis. Many studies confirmed the pivotal role of ultrasound in this procedure. Vascular access guidelines strongly recommend ultrasound guidance. Its usefulness has been demonstrated not only in reducing complications of venipuncture but more recently for the evaluation of central venous catheter (CVC) placement and real-time check for possible complications. The use of ultrasound requires a precise technique for the correct handling of the probe and the needle movement. Different approaches as the out-of-plane, in-plane, and oblique methods are available, enabling the most appropriate for the individual case. Although the learning curve for CVC ultrasound placement is usually fast, formal training and certification for beginners are strongly recommended.

Keywords: Ultrasound; catheter; central vein cannulation.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Ergonomics during the procedure for the internal jugular vein approach.
Figure 2.
Figure 2.
Scan terminology for vein and needle US manipulation.
Figure 3.
Figure 3.
Main steps of central vein US guided cannulation. (A) Pre-US evaluation (a) with compression of the vein (b) to confirm patency; thrombosis of the vein (c) compression of the vein by the artery (d). (B) Sterile preparation of the ultrasound machine and probe. (C) Echo guided puncture: (a) out-of-plane, (b) oblique in-plane, and (c) tent effect. (D) US check of the needle inside the vein. (E) Guidewire insertion and US control of its position inside the vein. (F) US control of catheter placementin the vein (a) and bubble effect in right atrium (b). (G) Post procedural US check for complications. Gliding side (a) and pleural effusion (hemothorax) (b).
See this image and copyright information in PMC

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