The superiority of real-time US-guidance (or “direct” US-guidance) has been demonstrated over indirect US-guidance (corresponding to a preprocedural US localization of the vessels, followed by a blind puncture). To reduce the incidence of immediate complications, it is recommended to use the real-time US-guidance for CVC as the first-line procedure in all puncture sites. US-guidance improves the efficiency, safety, and comfort during CVC. Earlier studies were extracted from international guidelines. All in-ICU or operating room studies regarding US-guided CVC with short-term catheters in adult patients since 2020 were screened and reviewed from the Pubmed database (Additional file 1). We will therefore detail new developments that will provide areas for research and improvement of CVC outcomes by firstly summarizing the latest international guideline recommendations in critical care (2020), and then by focusing on published innovations since this date. This narrative review aims to synthesize current evidence-based best practices for CVC use, and to highlight ways to improve the use and feasibility of real-time ultrasound (US)-guided puncture. They can lead to an increase in hospital length of stay, hospitalization costs and mortality in intensive care patients. Late complications (2%), corresponding mainly to catheter-related infections (CRI) and catheter thrombosis, and dislodgement. It has been largely reported that some patient (BMI < 20 kg m −2) and operator-related (male gender, limited experience, and ≥ 2 skin punctures) risk factors are associated with a higher rate of immediate complications. Immediate complications (8–15%), such as pneumothorax, arterial puncture, bleeding complications, cardiac arrhythmias, and catheter malposition. Although CVC is indicated to improve the management of intensive care patients, it is associated with complications that could be separated in two types, according to the timing of the venipuncture: The main sites for CVC insertion are the internal jugular vein (IJV), the subclavian (SV) or proximal axillary vein (AV), and the femoral vein (FV). Central venous catheterization (CVC) is indicated in nearly 75% of intensive care patients, allowing the administration of venotoxic drugs or vasopressors, vascular filling, parenteral nutrition, repeated blood sampling, and hemodynamic monitoring by central venous pressure measurement.
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