Utilidad del uso de la ultrasonografía para los accesos vasculares en los diferentes escenarios de la atención en salud: una revisión de alcance

Abstract

The insertion of central vascular access is crucial in 75% of patients in intensive care units for the administration of venotoxic drugs, hemodynamic monitoring, and parenteral nutrition. Common insertion sites include the internal jugular vein, the subclavian or proximal axillary vein, and the femoral vein, each with specific risks of immediate and delayed complications. Real-time ultrasound guidance has been noted for reducing immediate complications during central venous catheter insertion, although its use is limited by equipment availability and the perception of a longer procedure. Direct ultrasound guidance is superior to indirect guidance in reducing mechanical complications, though its impact on infection rates remains debated. Infraclavicular insertion is recommended to minimize delayed complications, though its use is less frequent due to perceived technical difficulty and the risk of pneumothorax. A pre-procedural ultrasound analysis is advised to detect anatomical anomalies and select the optimal site for catheterization. Subsequently, a vascular, cardiac, pleural, and pulmonary ultrasound analysis helps detect and prevent catheter malposition and pleuropulmonary complications. For subclavian vein cannulation, real-time ultrasound guidance has shown higher success rates and fewer complications, although the certainty of the evidence is limited. Two-dimensional ultrasound for the internal jugular vein significantly reduces complications and improves first-attempt success rates. Additionally, ultrasound guidance improves success rates and reduces complications in arterial and peripheral venous cannulation, proving to be safer and more efficient for hemodialysis catheter insertion compared to methods based on anatomical landmarks.