Ultrasound-Guided Vascular Procedures

Guidance for percutaneous vascular procedures at the bedside fits well within the paradigm for point-of-care ultrasound. The safety and efficacy of these procedures are enhanced by the use of dynamic ultrasound guidance. Substantial evidence from the literature supports the use of ultrasound guidance for vascular access and other bedside percutaneous vascular procedures. Multiple published reports have documented the advantages of ultrasound guidance in terms of procedural success and minimizing complications. Modern advances in transducer and image-forming technology allow the real-time acquisition of high-resolution images of regional vascular anatomy. Clear visualization of the access needle entering the target vessel is achievable with appropriate training. A set of learned skills in manipulating the probe and acquiring optimal needle visualization form a standard protocol which can be applied to multiple anatomic sites. In this chapter, we review ultrasound guidance for the injection of pseudoaneurysm, arterial access, midline catheter, and peripherally inserted central catheter (PICC) line placement.