Ultrasound Intravascular Access

Ultrasound use in establishing intravenous access has been extensively documented for over 20 years and is now routinely performed in many settings for nonemergent central line placements and difficult peripheral intravenous access. The literature has proven this procedure's safety and high success rate, thus its widespread integration in emergency departments (see Video. Forearm Anatomy Review and Ultrasound Probing). While not as commonly undertaken, ultrasound can also be utilized for arterial access and cannulation. Once mastered, the procedure is simple, effective, and safe—with little to no increased risk or contraindications. Limitations to using ultrasound for establishing intravenous access include the availability of ultrasound machines and the required training. Any time a procedure is contemplated, the alternatives should be considered as well. The primary alternatives to ultrasound-guided intravenous access are anatomic landmark-guided placement (traditional) and using the intraosseous, intramuscular, and oral routes, bypassing intravenous access. Other alternative adjuncts to aid intravenous access include devices made for transillumination.