A reply

Abstract

We would like to thank Drs Jefferson and Ball for their interest in our survey and welcome their comments. Our survey [1] was conducted in the latter half of 2006 over a 5-month period, 4 years after publication of NICE and 6 years after the authors’ survey [2]. We accept that the results from both surveys demonstrate there has been a marked increase in the availability of ultrasound in critical care areas and a subsequent increase in use for placement of central venous catheters. The authors state our survey can be used to compare the use of ultrasound in critical care before and after the NICE recommendations. This is indeed an interesting comparison; however, the authors’ survey was of lead consultants in critical care units and as such responses may have over- or under-estimated the use of ultrasound if lead clinicians were responding to the questionnaire in the context of unit policy and not individual practice. In fact, this criticism was made of our first survey [3] where we sought the opinion of departmental college tutors and this survey was the catalyst for the larger, recently published work which directly questioned individual senior anaesthetists, 23% of whom worked in critical care areas. We would reinforce our view that it is good practice to document the technique used for placement of central venous catheters, as supported by the Royal College of Anaesthetists [4]. This will facilitate audit of complications of central venous cannulation and potentially explore the lack of adoption of NICE guidance where this is present.