Two dimensional ultrasound guidance in central venous catheter placement; a postal survey of the practice and opinions of consultant pediatric anesthetists in the United Kingdom

Abstract

Recent guidelines from the UK National Institute for Clinical Excellence (NICE) recommend the use of ultrasound guidance for central venous catheter (CVC) insertion in children. We conducted a survey of pediatric anesthetists to determine current practice and opinion on the appropriate use of ultrasound guidance. A confidential postal questionnaire was sent to all members of the Association of Paediatric Anaesthetists working in the UK. After 4 weeks a follow-up questionnaire was sent to nonrespondents. Members were questioned on availability and use of ultrasound, and its place in clinical practice and training. A total of 250 questionnaires were returned, a response rate of 63%. Of those members who placed CVCs in children (n = 196), 85% had access to ultrasound, and 68% stated that they used ultrasound guidance. Thirty-nine percent of clinicians who used ultrasound did so routinely. The remaining 61% used either a landmark or an ultrasound technique depending on circumstances. Regarding its mandatory use, 76% of responders believed that ultrasound guidance was beneficial in certain circumstances but did not need to be used routinely. Seventy-five percent of responders agreed that all pediatric anesthetists should have training and access to ultrasound for CVC placement. In the UK most pediatric anesthetists placing CVCs in children currently have access to ultrasound guidance. Despite a lack of widespread support for its routine use, most agree ultrasound is a useful tool, and that all pediatric anesthetists should have access and training in the use of this technology.