Barriers To Ultrasound Use For Difficult Vascular Access

Srikumaran Selvarajah, Paramjeet Deol


This study looks to explore the current use of ultrasound guidance in difficult vascular access.


Vascular access is the most common invasive procedure in secondary care.

Patients in whom this proves difficult are often subjected to multiple failed attempts and delays in treatment.

Multiple studies have extolled the benefits of ultrasound guided peripheral access though its uptake is variable.

This study looks to explore the current use of ultrasound guidance in difficult vascular access


A survey of 200 doctors and nurses within London district general hospitals was conducted.

It focused on their current practice in the management of difficult vascular access and perceived barriers to the use of ultrasound.


Both the use of ultrasound to aid vascular access and confidence in succeeding increased with clinical seniority.

Junior trainees are likely to attempt cannulation in excess of 3 times before escalation.

In the case of difficult venous access, junior trainees were more likely to escalate to colleagues whilst more senior trainees attempted ultrasound guidance. Both out of plane and in plane techniques were reported.


Ultrasound has been shown to improve outcomes in those with difficult vascular access.

Failure to escalate to ultrasound guidance, results in increased delays in patient treatment, multiple failed attempts and increased senior workloads. Junior trainees are currently escalating to seniors instead of using ultrasound.

The increasing availability of ultrasound has led to this practice becoming unacceptable. An investment must therefore be made to train juniors in ultrasound guided vascular access. We have planned an ultrasound guided vascular access study day for trainees in London.

This will attempt to reduce senior escalation and increase confidence in its use.

References: Egan et al 2014. Heinrichs et al 2013

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