Table 5 Vascular ultrasound: expected core competencies and learning goals
From: Head to toe ultrasound: a narrative review of experts’ recommendations of methodological approaches
Procedure/condition | Imaging acquisition | Main findings/procedures | Training and learning curve |
|---|---|---|---|
Ultrasound-guided vascular access device placement | 1. Preliminary assessment | - Sonographic assessment of all possible venous options to choose the easiest and the safest approach | - Formal didactic or web-based teaching - Simulation lab: (a) healthy volunteers; (b) simulators (biological or computer-based) - Minimum passing score - 5 observed procedures of each kind - 5 proctored procedures of each approach - 30 ultrasound-guided vascula access placement of any kind within 1 year |
2. Ultrasound-guided puncture | - Suggested protocols for assessment: RaCeVA for cervical and thoracic vessels [84]; (b) RaFeVA for lower limbs and groin vessels [85]; RaPeVA for deep peripheral vessels [86] | ||
3. Ultrasound-based tip navigation | |||
4. Ultrasound-based tip location | - Follow the needle tip visualizing it into the vessel’s lumen | ||
5. Lung ultrasound to rule out possible respiratory mechanical complications | - Follow wires, dilator or microintroducer, and catheters while advancing through vessels tributary of the superior or inferior vena cava [87] | ||
6. Compressive ultrasound to rule out catheter-related thrombosis in case of signs and symptoms eventually associated to catheter’s malfunctioning | - Subcostal 4-chamber, subcostal bicaval or apical 4-chamber views to identify catheter’s tip at the junction between right atrium and superior or inferior vena cava [87, 88] - Perform lung ultrasound to rule out pneomothorax or hemothorax after a difficuly venipuncture or in case of sudden and otherwise unexplained worsening of respiratory or hemodynamic conditions [66] - Perform compressive ultrasound to exclude a clinically suspected catheter-related thrombosis (CRT) exploring all vessels starting from catheter’s entry point [66] - Ultrasound allows to distinguish between a true CRT and the fibrin sleeve | ||
Deep vein thrombosis (DVT) | Compressive ultrasound (CUS) in case of suspected deep vein thrombosis or pulmonary embolism | - 7.5–15 MHz linear probe - CUS of common femoral vein at the groin and its conluence with great saphenous vein - CUS of superficial femoral vein at the mid-tight - CUS of popliteal vein in the popliteal fossa | 2 to 10-h course 25 to 50 proctored examinations |