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Ultrasound for central vascular access. A safety concept that is renewed day by day: review

Background: Ultrasound (US)-guided central venous catheterization is intended to reduce complications, enhance success rates on the first attempt, and increase accuracy, thus becoming a standard in clinical practice. Objective: To review the relevant literature on the importance of US as a guide to central venous access and to describe the benefits of this tool and the impact of its use on the safety of the procedure. Methods: A narrative review of various medical literature databases and recognized guidelines (National Guideline Clearinghouse, New Zealand Guidelines, National Institute for Clinical Excellence, Cochrane, and JAMA). Results: High-quality evidence recommends US-guided internal jugular vein access as the preferred approach in routine practice. However, different other anatomical sites may be necessary for vascular access depending on the clinical setting. Related complications associated with landmark-guided techniques range between 0.3% and 18.8% and depend on multiple conditions such as patient characteristics and access site. US has been associated with a reduction in the relative risk of complications, failed attempts, and failed first attempt of 57%, 86%, and 41%, respectively. Conclusion: US should be used routinely in central vascular access. Current evidence supports this recommendation for the internal jugular vein approach, but no so for the other approaches, in cases of difficult or failed access using conventional approaches.