Ultrasound Guidance for Vascular Access

Ultrasound guidance has become an important tool for improving the safety and success of vascular access. In this position statement, the Society of Hospital Medicine developed evidence-based recommendations for ultrasound-guided central venous, peripheral venous, and arterial access in adult patients.

For patients with difficult peripheral venous access, the authors specifically recommend real-time ultrasound guidance to reduce procedure time, needle insertion attempts, and needle redirections. Ultrasound-guided peripheral IV placement may also provide an effective alternative to central venous catheter placement in appropriately selected patients.

Importantly, the recommendations extend beyond simply having an ultrasound machine available. Providers should assess vessel anatomy, size, depth, and potential thrombosis before insertion; use real-time rather than static ultrasound guidance; and maintain visualization of the needle during vascular access procedures.

The position statement also emphasizes education and competency. Structured training should combine didactic education, simulation, supervised clinical practice, standardized competency assessment, and periodic reassessment to maintain proficiency.

Practice Takeaway:
Effective ultrasound-guided vascular access is more than a procedural skill. It requires appropriate patient and vessel assessment, real-time needle visualization, deliberate training, and continued competency development. When those pieces come together, ultrasound can reduce unnecessary attempts and support safer, more efficient vascular access.

Reference: Franco-Sadud R, et al. Recommendations on the Use of Ultrasound Guidance for Central and Peripheral Vascular Access in Adults: A Position Statement of the Society of Hospital Medicine. Journal of Hospital Medicine. 2019;14:E1–E22.