Ultrasound Guidance for Vascular Access Procedures by Qualified Vascular Access Specialists or Other Applicable Healthcare Clinicians

Ultrasound guidance for vascular access procedures has been used in clinical practice among a variety of health-care practitioners for more than 30 years. The ability to visualize underlying structures of the upper and lower extremities, chest, and neck results in improved success, speed, patient safety, and patient satisfaction. Ultrasound not only aids in superior procedural advantages, it also provides a platform to perform a thorough assessment of the vascular structures to evaluate vessel health, viability, size, and patency and locates other important and best-avoided anatomical structures as well as venous and arterial abnormalities.Recommendations for the use of ultrasound is now supported by many professional organizations (see Appendix for list of supporting organizations) for vascular access procedures and is now widely accepted to promote safe and accurate insertion of vascular devices. To ensure procedural safety and high success rates, there are recommendations for the use of a systematic approach for ultrasound-guided vascular access procedures. A standardized approach minimizes variability in clinical practice, provides a framework for education and training, facilitates implementation, and enables quality analysis.In the last 2 decades, there have been multiple publications demonstrating significantly increased safety, effectiveness, and efficiency of ultrasound-guided vascular access as compared to cannulation by anatomic landmarks and/or acoustic Doppler.1–3 A systematic review4 looking at internal jugular vein (IJV) cannulation highlighted that the use of two-dimensional ultrasound reduced the rate of total complications overall by 71%, that overall success rates were modestly increased in all groups combined at 12%, and that similar benefit was noted across all subgroups. Not only does this confirm that ultrasound use is superior in IJV cannulation, but it also had a flow-on effect for other cannulated vessels when used by practitioners with appropriate training and experience. The use of two-dimensional ultrasound increased the chance of success at the first attempt by 57% and reduced the chance of hematoma formation.4 The authors concluded that two-dimensional ultrasound offers gains in safety and quality when compared to an anatomic landmark technique.4Use of ultrasound is also strongly supported by an expert review of ultrasound guidance that recommends its use not only for central venous cannulation5 but also for peripheral and arterial device placement. The authors also state ultrasound can be utilized to check for immediate and life-threatening complications, as well as for confirming catheter tip position.5Regardless of its increasing use, there is still some avoidance in the successful and safe implementation of ultrasound into vascular access clinical practices. This is often due to various reasons, which will not be discussed here, but this valuable tool does require additional training and experience for all practitioners who plan to utilize it in their clinical practice. Local competencies must be in place for practitioner compliance.Healthcare professionals involved in the placement of vascular access devices (VADs) using ultrasound guidance need appropriate education and simulation training to ensure patient safety and avoid major complications with the insertion of VADs.6–18 Knowledge of anatomy, ultrasound physics, and imaging techniques, as well as infection prevention strategies, are proposed for standard didactic education.519–32 These recommended topics are necessary for adequate understanding and safe use of ultrasound technology for all vascular access procedures.It is the position of AVA that a properly qualified vascular access specialist or other applicable healthcare clinician use real-time ultrasound for all vascular access procedures.Given the diversity and variability of healthcare facilities, personnel, organizational capabilities, and practices, AVA recommends the following for the use of ultrasound for vascular access:The recommendation for individual ultrasound accreditation currently is unresolved and is based on each healthcare system's accreditation requirements. International consensus concluded that such accreditation is not mandatory and should be left to each healthcare organization's policy and procedure process, endorsed with current clinical evidence. Clearly, once competency is achieved, there must be active engagement by the individual healthcare practitioner to ensure these competencies are maintained and continual professional development and assessment is ongoing.The use of ultrasound by vascular access specialists and applicable healthcare clinicians provides a standardized technology platform for impacting key areas in healthcare, highlighting the benefits in patient safety and minimization of device-related trauma, as well as decreasing insertion-related complications. There is a need to clearly define the required competencies, which constitute vascular access ultrasound for vascular access specialists and applicable healthcare clinicians, and these competencies need to be detailed and specific for the specialty.This document is meant to serve as a basis for evidence-based decision making. Nothing contained within this position paper should take the place of following a medical device's approved instructions for use provided by the manufacturer.The AVA was founded in 1985 to promote the emerging vascular access specialty. Today, AVA stands at the forefront of protecting and saving lives via establishing best practices and promoting patient advocacy. AVA's multidisciplinary membership advances research, provides professional and public education to shape practice and enhance patient outcomes, and partners with the device manufacturing community to bring about evidence-based innovations in vascular access. To learn more or join, visit www.joinAVAnow.com.