Central venous cannulation: ultrasound techniques

Central venous cannulation is commonly undertaken by a range of specialities in diverse clinical settings. Central veins may be cannulated by the landmark, ultrasound-guided or open surgical cut-down techniques. Complications of central venous catheter (CVC) insertion are common and may lead to significant morbidity and very occasional mortality. Two-dimensional ultrasound-guided central venous catheter placement has been shown by randomized controlled trials to be superior to the landmark technique. It reduces both the number of needle passes required for successful placement and the incidence of complications. Constant needle-tip visualization is a challenge for the novice operator. The UK National Institute for Health and Care Excellence (NICE) has recommended since 2002 that following appropriate training, clinicians should use ultrasound wherever practical in both elective and emergency internal jugular vein catheterization. Most clinicians would now recommend its use for all routes of access.