EditorialUltrasound-guided central venous cannulation: Seeing clearer, being safer☆,☆☆
Section snippets
Why this topic deserves our attention
In the United States alone, more than 5 million central venous catheters (CVCs) are attempted annually, of which, conservatively, 10% are associated with complications [1], [2]. Without including data from any other nation, this means our specialty performs thousands of daily CVCs and oversees hundreds of quotidian complications. It is safe to conclude—although “safe” may be precisely the wrong word—that although CVCs are routine, they can also be routinely perilous. For something so common, we
Why this work helps us see clearer
Despite limitations, this is the largest questionnaire tailored to study bedside ultrasound in CVC insertion. This work could facilitate discussions between clinicians, educators, and administrators alike. Moreover, replies came from each state in the nation save one (Wyoming was apparently unavailable for comment), and conclusions were consistent across regions. The survey numbers also substantially exceeded previous attempts: Backlund (n = 116), Ballard (n = 365), and Buchanan (n = 919) [4],
Where to look next
Although it is one thing to agree that much work remains to be done, it is another to coordinate, fund, and sustain efforts. Much like ultrasound, you can spotlight one area (but potentially miss the bigger picture) or spread your energy widely (but skip something important). Beyond the usual platitudes, namely, that we must redouble efforts, ensure consistent access, and provide regular education, the picture is "fuzzy". After all, the reluctance to use ultrasound is despite over a decade of
Achieving a better view
Ultrasound laudably demonstrates that vascular anatomy commonly differs from the textbook. However, we should also accept that ultrasound may be relied upon when practitioners are insufficiently versed in surface anatomy. Moreover, for those who are proficient with surface anatomy, it seems unfair to conclude that not using an ultrasound throughout means that you are working “blind.” Anecdotally, our experience is that increased ultrasound use can mean decreased placement of patients into
In closing
The “Mindset List” [14] is published annually with the goal of explaining to the older generation those objects and values that will inform the future. For example, by emphasizing that younger people have never known a world without Internet or social media, we “curmudgeons” might better relate, educate, and engage. This approach might also illuminate the ongoing ultrasound debate.
Older practitioners' training is usually high volume, without ultrasound, and emphasized confidence over caution.
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Emergency physician perspectives on central venous catheterization in the emergency department: a survey-based study
Acad Emerg Med
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Use of ultrasound guidance for central venous catheter placement: survey from the American Board of Emergency Medicine. Longitudinal study of emergency physicians
Acad Emerg Med
(2014) Wikipedia
Risk homeostasis
Cited by (1)
Barriers for ultrasound-guided central venous catheterization in Iran
2016, Journal of Critical Care
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Disclosures/conflicts: None.
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Declaration: This work is original and is not under consideration elsewhere.