Abstract
Ultrasound-guided central vein catheterization (US-CVC) is expected to become the new standard method for central vein catheterization, considering the accumulated evidence for its high success rate and low complication rate. Recently, however, there have been an increasing number of reports of complications related to US-CVC.
Therefore, I have reevaluated the evidence for US-CVC. I have focused on the anatomical landmark techniques (AL-CVC) that have been used in the major evidence-based studies for central vein catheterization. The analysis showed that the procedures used for AL-CVC can be classified into several types of approaches and have not been standardized. Furthermore, some of these studies have not described the procedure in detail. The analysis suggests that these studies have some bias for US-CVC versus AL-CVC.
If an operator performing AL-CVC has the basic anatomical knowledge required to successfully perform the procedure and avoid complications, it should be possible to obtain results that are as good as those obtained using US-CVC. If an operator performing US-CVC feels that the procedure is simple because of the involvement of ultrasonography and does not take adequate precautions, the procedure might fail in spite of the evidence available.
