Ultrasound Intravascular Access

Ultrasound (US) guidance for intravenous (IV) access has been well documented for more than 20 years and is now routine in many settings for non-emergent central line placement and difficult peripheral IV access. The safety and high success rate of US-guided IV access have been proven in the literature, and this effectiveness is the reason for such widespread integration in emergency departments. While not as common, ultrasound can also be utilized for arterial access and cannulation. Once mastered, the procedure is simple, effective, safe, and presents little to no increased risk or contraindications. Limitations to the use of US for IV access include the availability of US machines and training required.Anytime a procedure is considered, the alternatives should be considered as well. The primary alternatives to US-guided IV access are anatomic landmark-guided placement (traditional), intraosseous access, or not obtaining IV or IO access (using intramuscular and oral routes). Other alternative adjuncts to aid in IV access include devices made for trans-illumination.