From the June 2011 issue of HealthCare Business News magazine

Ultrasound at the point of care also improves patient safety, a crucial goal for both physicians and administrators, given the high rate of medical errors that have recently been reported. The NEJM found that, “With appropriate use, point-of-care ultrasonography can decrease medical errors, provide more efficient real-time diagnosis.”

Physicians often employ ultrasound at the point of care as a safe way to guide certain invasive procedures, such as nerve block injections, central line placement, and fluid drainage, including thoracentesis and paracentesis. Ultrasound guidance of catheterization of the internal jugular vein reduces the rate of catheter-related bloodstream infections by 35 percent, offering significant cost savings. The Centers for Disease Control and Prevention estimate that the marginal costs to the healthcare system of a single catheter-related bloodstream infection is $25,000.


For placing central lines, the Agency for Healthcare Research and Quality (AHRQ) identifies ultrasound guidance as one of 11 patient safety practices warranting widespread adoption. AHRQ found that “real-time ultrasound guidance for CVC insertion…improves catheter insertion success rates, reduces the number of venipuncture attempts prior to successful placement and reduces the number of complications associated with catheter placement.” Complications, including pneumothorax, are reduced substantially, with a relative risk reduction of 78 percent.

A NICE guideline
In the United Kingdom, the National Institute of Clinical Excellence (NICE) has issued national guidelines recommending ultrasound guidance as the preferred method to lower the risk of such serious complications as collapsed lung, arterial puncture, nerve injury, and arteriovenous fistula. It’s now become the standard of care. In the U.S., many top medical centers have adopted an institution-wide policy requiring ultrasound guidance for all central line placements. The 2011 CDC Guidelines for the Prevention of Intravascular Infections list the use of ultrasound for central venous catheter placement to reduce the number of cannulation attempts and mechanical complications.

The rationale is simple: It’s safer to place a central line when physicians can see the jugular vein under ultrasound, instead of working blindly. Since patients’ anatomy can vary, landmark methods are also more likely to result in multiple insertion attempts, with initial failure rates of up to 35 percent reported in medical literature.

June 2011 Magazine

Read more stories from the June 2011 issue

More Magazine Features

More Voices