The Bottom Line on Point-of-Care Vascular Ultrasound

Introduction to POCUS: vascular

Why Learn it?

Imaging arteries and veins has a veritable cornucopia of uses.

  • In diagnostics:
    • DVT assessment
    • Assessment of fluid status (using IVC, internal jugular or subclavian collapsibility/distensibility indices)
    • Detecting arterial pathologies (aneurysms, dissection, thrombi)
    • Assessment of fluid responsiveness using carotid/brachial flow time measurement
  • In therapeutics:
    • Ultrasound for central line placement is considered the gold standard of care in many critical care units worldwide, and is a core skill in many hospital-based medical specialties.
    • Arterial lines, peripheral cannulae, ECMO cannulae, and interventional radiological procedures can all be ultrasound guided.

 

Limitations/Challenges

  • Training/maintaining competency can be a challenge outside of anaesthesia
  • Controversies with ultrasound for vascular access include technique, complication rate (reduced but not eliminated) and whether over reliance on ultrasound leads to de-skilling of the landmark techniques.
  • Optimal technique to teach for DVT assessment (2 point compression, 3 point compression, or comprehensive scan) unclear
  • Vascular assessment of fluid responsiveness full of pitfalls- false positives (high tidal volumes, normal variant) false negatives (raised IAP, high PEEP, RV failure)  a large gray zone, and limited validation.

Resources

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