title: Use of ultrasound guidance for central venous catheterization: a national survey of intensivists and hospitalists.
abstract: The purpose of the study is to evaluate the frequency and barriers to use of ultrasound guidance for central venous catheter (CVC) insertion by physicians specializing in critical care and hospital medicine.
  
  
  
  A national cross-sectional electronic survey of intensivists and hospitalists was administered from November 2014 to January 2015.
  
  
  
  The survey response rate was 5.9% (1013/17 233). Moderate to very frequent use of ultrasound guidance varied by site: internal jugular vein (80%), subclavian vein (31%), and femoral vein (45%). Nearly all physicians (99%) who insert internal jugular CVCs daily use ultrasound guidance, whereas only 46% of physicians who insert subclavian CVCs daily use ultrasound guidance. Use of real-time ultrasound guidance varied by insertion site: internal jugular vein (73%), subclavian vein (28%), and femoral vein (42%). Most physicians (59%) reported not being comfortable with real-time needle tracking at the subclavian site. The most frequently reported barriers to use of ultrasound guidance were (1) limited availability of ultrasound equipment (28%), (2) perception of increased total procedure time (22%), and (3) concern for loss of landmark skills (13%).
  
  
  
  Most intensivists routinely use ultrasound guidance to insert internal jugular CVCs but not subclavian CVCs. The most commonly reported barrier to ultrasound use was limited access to an ultrasound machine.
authors: Division of Hospital Medicine, University of Texas School of Medicine in San Antonio, TX 78229; Division of Pulmonary and Critical Care Medicine, University of Texas School of Medicine in San Antonio, TX 78229; Section of Pulmonary and Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX 78229. Electronic address: sonin@uthscsa.edu.
authors: Nilam J
authors: NJ
authors: Soni
authors: Division of Pulmonary and Critical Care Medicine, University of Texas School of Medicine in San Antonio, TX 78229.
authors: Luis F
authors: LF
authors: Reyes
authors: Division of Pulmonary and Critical Care Medicine, University of Texas School of Medicine in San Antonio, TX 78229; Section of Pulmonary and Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX 78229.
authors: Holly
authors: H
authors: Keyt
authors: Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA 02114.
authors: Alejandro
authors: A
authors: Arango
authors: Department of Epidemiology & Biostatistics, University of Texas Health Science Center, San Antonio, TX 78229.
authors: Jonathan A
authors: JA
authors: Gelfond
authors: Division of Pulmonary and Critical Care Medicine, University of Texas School of Medicine in San Antonio, TX 78229; Section of Pulmonary and Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX 78229.
authors: Jay I
authors: JI
authors: Peters
authors: Division of Pulmonary and Critical Care Medicine, University of Texas School of Medicine in San Antonio, TX 78229; Section of Pulmonary and Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX 78229.
authors: Stephanie M
authors: SM
authors: Levine
authors: Division of Pulmonary and Critical Care Medicine, University of Texas School of Medicine in San Antonio, TX 78229; Section of Pulmonary and Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX 78229.
authors: Sandra G
authors: SG
authors: Adams
authors: Division of Pulmonary and Critical Care Medicine, University of Texas School of Medicine in San Antonio, TX 78229; Section of Pulmonary and Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX 78229.
authors: Marcos I
authors: MI
authors: Restrepo
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous / Q000379:methods*; D062905:Central Venous Catheters; D003422:Critical Care; D003430:Cross-Sectional Studies; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging*; D020445:Hospitalists; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D013350:Subclavian Vein / Q000000981:diagnostic imaging*; D011795:Surveys and Questionnaires; D014463:Ultrasonography / Q000706:statistics & numerical data*; D014481:United States
keywords: Central venous catheterization; Central venous catheters; Femoral vein; Jugular vein; Subclavian vein; Ultrasound