Ultrasound Theory and Point of Care Application

The use of point of care ultrasound is the new standard of vascular access and allows for increased success rates and the avoidance of complications associated with blind sticks. Point of care ultrasonography is defined as ultrasound brought to the bedside to provide a real time 2D grey scale visual aid for invasive procedures (23).

The use of ultrasound guidance has resulted in improved success and decreased complications associated with CVC placements. There are two ultrasound guided techniques: Static and dynamic (24). The static technique involves identifying the structure or vessel, marking the area of insertion on the skin and then proceeding without visual aid. When using the dynamic technique, you are able to visualize the needle in real time throughout the insertion process. The use of ultrasound during central line insertions has been shown to reduce the failure rate, the risk of complications, and the number of attempt when compared with landmark technique. This is particularly true in the case of less experienced users or patients with complex conditions. (25,26).

When performing dynamic vascular access an in-plane, long axis approach is preferred as it allows you to see the entire length of the needle including the tip throughout the procedure (24).