“In the most severely ill patients, the choice of peripheral vs central venous line (CVL) remains difficult. Even if the CVL utilization ratio is 70.1% of the patient-days in Europe, the decision of CVL insertion should be carefully balanced with the risk of complications (Fig. 1). Ultrasound insertion should be used to limit mechanical complications, especially in case of internal jugular and subclavian insertion. However, strict aseptic surgical conditions should be adopted to prevent the risk of infections suggested by post hoc analyses of randomized controlled trials (RCTs) . Femoral access, associated with a similar risk of infectious complications and a higher risk of thrombosis with respect to jugular access, should be used in case of hemostasis disorders . Similarly, ultrasound guidance can also be used to maximize successful cannulation of midline, peripherally inserted central catheters (PICCs) and peripheral veins in patients with difficult or tenuous vascular access.”Reference:
Timsit JF, Tabah A, Mimoz O. Update on prevention of intra-vascular accesses complications. Intensive Care Med. 2022 Jun 29. doi: 10.1007/s00134-022-06763-5. Epub ahead of print. PMID: 35768729.