(Originally presented by Dr Jireh Tsuh)
Arterial injury still occurs with ultrasound-guided CVC placement
Multiple methods of confirmation of venous entry:
- Manometry
- Transduction
- Blood gas
- Ultrasound
- “Eyeball”
Some methods are better than others, but none are perfect – using multiple methods maybe ideal.
Manometry and transduction should be done on a catheter rather than needle (which can migrate).
The needle rarely does the damage, however the large bore dilator can cause significant vascular injury.
It’s not just the carotid – the subclavian/ innominate arteries can be closely associated with the jugulars, especially low in the neck.
If arterial cannulation – contact vascular for repair!
Further reading:
St George Anaesthesia Education 