What are the novel or noteworthy applications of Point-of-Care Ultrasound (POCUS) for vascular access and interrogation?

From the Guidelines

Point-of-Care Ultrasound (POCUS) is a crucial tool for vascular access and interrogation, offering numerous novel applications that enhance patient care and procedural safety, as evident from the international evidence-based recommendations on ultrasound-guided vascular access 1. The most significant applications of POCUS in this context include:

• Ultrasound-guided peripheral intravenous access, which increases first-attempt success rates and reduces complications
• Central venous catheter placement under real-time ultrasound guidance, decreasing the risk of pneumothorax and arterial puncture
• Rapid assessment of inferior vena cava diameter and collapsibility to evaluate volume status
• Preservation of vascular access in dialysis patients by identifying suitable vessels and detecting complications
• Ultrasound-guided arterial line placement, particularly beneficial in hypotensive patients or those with anatomical variations

When performing these procedures, using sterile technique with probe covers, appropriate depth settings, and visualization in both short and long axis views is essential for optimizing success 1. The physics behind ultrasound's utility involves high-frequency sound waves that reflect differently from blood, vessel walls, and surrounding tissues, creating real-time images that allow practitioners to navigate anatomy safely and effectively. Key considerations for the use of POCUS in vascular access include:

• The importance of real-time ultrasound needle guidance for minimizing complications and optimizing the probability of needle placement
• The definition of ultrasound-guided cannulation, which involves ultrasound scanning to verify the presence and position of a suitable target vessel before skin puncture, followed by real-time ultrasound imaging to guide the needle tip throughout the vessel puncture process
• The role of ultrasound in assessing vessel size, depth, patency, and proximity to vital structures, thereby facilitating the choice of the optimal target vessel for cannulation

Overall, the integration of POCUS into clinical practice for vascular access and interrogation is supported by strong evidence, highlighting its potential to improve patient outcomes and reduce complications 1.

From the Research

Novel Applications of Point-of-Care Ultrasound (POCUS) for Vascular Access and Interrogation

• POCUS is used to confirm central venous catheter placement and evaluate for postprocedural complications, such as pneumothorax and misdirected catheters 2
• Real-time ultrasound guidance can improve the success of umbilical venous cannulation in neonates with congenital heart disease, with a success rate of 72% in patients who had failed traditional blind techniques 3
• POCUS can be used to guide vascular access, including challenging venous and arterial catheter placements, in the perioperative and critical care settings 4
• POCUS allows for rapid, real-time evaluation of cardiovascular and respiratory pathology, enabling clinicians to begin immediate investigation into their differential diagnoses without waiting for a formal imaging study 5
• The use of ultrasound for vascular access can reduce complications associated with cannulation of veins and arteries, such as those associated with central venous catheters and arterial pressure catheters 6

Benefits of POCUS for Vascular Access and Interrogation

• Reduced complications associated with vascular access procedures
• Improved success rates for challenging catheter placements
• Rapid and real-time evaluation of cardiovascular and respiratory pathology
• Enhanced speed of clinical interpretation and decision making
• Ability to inform clinicians of patients' response to interventions when serial exams are obtained 2, 3, 4, 5

Emerging Trends and Applications

• Use of POCUS for umbilical venous cannulation in neonates with congenital heart disease 3
• Application of POCUS in the perioperative and critical care settings for vascular access and other procedures 4
• Expansion of POCUS use across the hospital setting and within medical training programs 5
• Development of new technologies and techniques, such as handheld devices and real-time ultrasound guidance, to enhance the use of POCUS for vascular access and interrogation 6, 2, 3, 4, 5