AIUM Practice Parameter for the Use of …

1 AIUM Practice Parameter for theUse of ultrasound toGuide Vascular AccessProcedures 2012 by the American Institute of ultrasound in Medicine parameters developed in conjunction with the American Academy of PhysicianAssistants (AAPA), the American Association of Critical Care Nurses (AACN), the American Association of Nurse Anesthetists (AANA), the American Society ofDiagnostic and Interventional Nephrology (ASDIN), the American College ofEmergency Physicians (ACEP), the American Society of Echocardiography (ASE), the Association of Physician Assistants in Cardiovascular Surgery (APACS), the Association for Vascular Access (AVA), the Infusion Nurses Society (INS), the Renal Physicians Association (RPA), the Society of Diagnostic Medical Sonography (SDMS), and the Society for Vascular ultrasound (SVU).

2 12/1/15 3:47 PM Page 1 The American Institute of ultrasound in Medicine (AIUM) is a multi-disciplinary association dedicated to advancing the safe and effectiveuse of ultrasound in medicine through professional and public education, research, development of parameters , and accreditation. To promote this mission, the AIUM is pleased to publish this AIUMP ractice Parameter for the Use of ultrasound to Guide Vascular AccessProcedures, established collaboratively with many organizationswhose members perform vascular access.

3 We are indebted to themany volunteers who contributed their time, knowledge, and energy to bringing this document to AIUM represents the entire range of clinical and basic scienceinterests in medical ultrasound , and, with hundreds of volunteers, theAIUM has promoted the safe and effective use of ultrasound in clinicalmedicine for more than 50 years. This document and others like it willcontinue to advance this parameters of the AIUM are intended to provide the medicalultrasound community with parameters for the performance andrecording of high-quality ultrasound examinations.

4 The parametersreflect what the AIUM considers the minimum criteria for a completeexamination in each area but are not intended to establish a legal stan-dard of care. AIUM-accredited practices are expected to generally fol-low the parameters with recognition that deviations from these param-eters will be needed in some cases, depending on patient needs andavailable equipment. practices are encouraged to go beyond theparameters to provide additional service and information as Sweitzer Ln, Suite 100 Laurel, MD 20707-5906 USA800-638-5352 2012 American Institute of ultrasound in 12/1/15 3:47 PM Page 2 Table of and Scope of This of the ultrasound User for Vascular Considerations for ultrasound -Guided Vascular AccessA.

5 Short-Axis (Out-of-Plane) Versus Long-Axis (In-Plane) VisualizationB. Differentiating Arteries From VeinsC. Static Versus Dynamic ultrasound GuidanceD. One-Person Versus Two-Person TechniqueE. Site Selection and PreparationF. Performing the ProcedureG. Use of ultrasound After the ProcedureH. Adjunctive Equipment and of Specific ultrasound -Guided Access ProceduresA. ultrasound -Guided Central Venous Guidance for Internal Jugular and Evidence for ultrasound Guidance in Internal Jugular for ultrasound -Guided Internal Jugular Guidance for Subclavian/Axillary and Vein ultrasound Guidance Guidance for Femoral Venous and for ultrasound -Guided Femoral Guidance for Arterial Access and for ultrasound -Guided Arterial Guidance for Peripherally Inserted Central and for ultrasound -Guided Peripherally Inserted Central Catheter Peripheral Venous and A.

6 Written ElementsB. Image RetentionVII. Equipment SpecificationsVIII. Quality Control and Improvement, Safety, Infection Control, and Patient Education ConcernsAcknowledgmentsReferences2012 AIUM Practice Parameter Use of ultrasound to Guide Vascular Access 12/1/15 3:47 PM Page and Scope of This DocumentThe contents of this Parameter were developed collaboratively among the AIUM and otherorganizations whose members use ultrasound for guidance in vascular access procedures. This Parameter has been developed by and for clinicians from diverse specialties and practi-tioner levels who perform vascular access.

7 While vascular access may be performed using exter-nal landmarks, point-of-care ultrasonography is now increasingly used, ultrasound guidance for vascular access has been shown to improve success rates while reduc-ing iatrogenic injury, the number of needle passes, and infection , it mayimprove patient comfort and Parameter is intended to be evidence based when possible and to include selected refer-ences of importance, but is not meant to be a comprehensive or rigorous literature review, asthis has been accomplished intent of this document is to highlight appropriateevidence while also providing practical, real-world expert consensus from clinicians withdiverse backgrounds on the best use and techniques for incorporating ultrasound into vascularaccess procedures with the ultimate goal of improving the care of our may be used to aid in central venous, peripheral venous, or arterial access proce-dures.

8 When used appropriately by qualified personnel, there are no absolute contraindicationsto using ultrasound as a procedural adjunct for vascular guidance. Based on evidence and theconsensus opinion of the collaborating organizations, ultrasound should be used whenever feasible in higher-risk procedures such as internal jugular (IJ) central venous access and for allelective jugular vein dialysis catheter the evidence for ultrasound guidancein other vascular access procedures and situations is less robust, there is a consensus opinionthat, with the exception of routine peripheral venous access in adults, ultrasound guidance offers substantial cumulative benefits in terms of safety and success.

9 Clinicians routinely performingvascular access procedures should have access to appropriate ultrasound equipment, should beadequately trained in the use of ultrasound for procedural guidance, and should understand thebenefits and limitations of using ultrasound to guide vascular access AIUM Practice Parameter Use of ultrasound to Guide Vascular Access Additional organizations represented during the drafting of these parameters include: the American College of Cardiology (ACC),the American College of Radiology (ACR), the American Registry for Diagnostic Medical Sonography (ARDMS), the AmericanSociety of Anesthesiologists (ASA), the American Society of Nephrology (ASN), the Society for Critical Care Medicine (SCCM),the Society of Radiologists in ultrasound (SRU), and the Vascular Access Society of America (VASA).

10 12/1/15 3:47 PM Page of the ultrasound User for Vascular AccessIt is assumed that practitioners who perform vascular access are performing this procedurewithin their scope of Practice , with or without ultrasound . Training and determination of com-petency for the use of ultrasound in procedural guidance will be defined by the practitioner srespective specialty but should include basic didactic training in principles and Practice of ultra-sound, instruction in the techniques of ultrasound guidance for vascular access, and proctoredassessment of competency in a simulated or actual patient care ,5, Considerations for ultrasound -Guided Vascular AccessAs with all procedures.