Is useful for beginners, in children, and when blind cannulation fails

Central venous catheters are used for haemodynamic monitoring, giving vasopressors and cytotoxic drugs, sampling blood, and giving fluids and parenteral nutrition.1 The main access sites are the internal jugular and subclavian veins. Placing central venous lines entails risks. Rates of major and minor mechanical complication can be as high as 10%. They depend on the experience of the operator, the access site chosen, the condition of the patient, the presence of atypical vascular anatomy, the coagulation status of the patient, and previous catheterisations. Complications include puncturing an artery, nerve injury, pneumothorax, and incorrect positioning of the catheter. Failure to cannulate the vessel may occur in over 19% of patients.1 The standard technique for placing central venous catheters is by using anatomical landmarks.1 Since 1984 many authors have recommended ultrasound guidance to optimise the success rate of cannulations and minimise complications.2

Two devices are mainly used. Based on conventional two dimensional ultrasound imaging, portable lightweight battery operated real time devices have been developed that are especially designed for viewing the internal jugular vein and the carotid …