title: Quality improvement: ultrasonography-guided venous catheterization in organ transplantation.
abstract: OBJECTIVE
  Central venous catheterization (CVC) is a procedure, not exempt of risk. Transplantation patients represent by themselves a high-risk group for CVC. Ultrasonography provides us of the exact localization of the target vein and its relationship with artery and nerve structures, detecting anatomic variations and thromboses of vessels. A description of technical skills, a review of the clinical evidence of ultrasonography-guided CVC and basic training guidelines are presented.
  
  
  RESULTS
  The internal jugular vein is the most common target vein selected because it is easier and safer, therefore it is the target vein recommended for learning the ultrasonography procedure. For subclavian-axillar vein insertion, the more distal (deltoid) access is the preferred approach; the supraclavicular access has been described with high success in paediatric patients. Anatomic variations of the venous system are not uncommon; small size, overlap artery and tissue oedema around the neck are the main causes of CVC failure. Training guidelines for ultrasound-guided vascular catheterization are necessary, and skill maintenance is crucial.
  
  
  CONCLUSIONS
  Ultrasonography-guided venous catheterization is an easily learned technique for internal jugular vein insertion, with significant improvements in overall success in those patients in whom a difficult vein access can be anticipated.
authors.affiliation: Department of Anaesthesiology and Reanimation, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain. asabatep@bellvitgehospital.cat
authors.forename: Antoni
authors.initials: A
authors.lastname: Sabate
authors.forename: Maylin
authors.initials: M
authors.lastname: Koo