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Ultrasound-guided vascular access in intensive/acute cardiac care 

Ultrasound-guided vascular access in intensive/acute cardiac care
Chapter:
Ultrasound-guided vascular access in intensive/acute cardiac care
Author(s):

Richard Paul

DOI:
10.1093/med/9780199687039.003.0021

February 22, 2018: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

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date: 22 October 2019

Vascular access is an essential requirement for the care of the critically ill cardiac patient, being necessary for drug and fluid delivery and monitoring of a patient’s haemodynamic response to an instigated therapy. The most common vascular access procedures conducted in the acute cardiac care unit are central venous and peripheral venous access, and arterial cannulation. Traditional landmark methods are associated with complication rates, ranging from 18 to 40%, depending on the site of access. The use of ultrasound to guide venous and arterial access has been shown to reduce the incidence of complications, such as inadvertent arterial puncture and pneumothorax formation (venous) and posterior wall puncture (arterial), to reduce the time taken and number of attempts to place a catheter, and to reduce the incidence of complete failure to insert a vascular access device. Since 2002, international consensus groups have published recommendations that two-dimensional ultrasound guidance be the preferred method for elective and emergency internal jugular catheter insertion. This chapter explores the evidence for the use of ultrasound to guide vascular access across multiple sites of insertion and describes the basic equipment and techniques necessary for successful deployment.

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