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Insertion of vascular access is a common procedure with potential for iatrogenic events, some of which can be serious. The spread of ultrasound scanners in operating rooms, intensive care units and emergency departments has made ultrasound-guided catheterisation possible. The first guidelines were published a decade ago but are not always followed in France. The French Society of Anaesthesia and Intensive Care has decided to adopt a position on this issue through its Guidelines Committee in order to propose a limited number of simple guidelines. The method used was the GRADE(®) method using the most recently published meta-analyses as the source of references. The level of evidence found ranged from low to high and all the positive aspects associated with ultrasound guidance, i.e. fewer traumatic complications at puncture, probably or definitely outweigh the potential adverse consequences regardless of whether an adult or child is involved and regardless of the site of insertion., (Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.)

Purpose: To provide clinicians with an evidence-based overview of all topics related to ultrasound vascular access., Methods: An international evidence-based consensus provided definitions and recommendations. Medical literature on ultrasound vascular access was reviewed from January 1985 to October 2010. The GRADE and the GRADE-RAND methods were utilised to develop recommendations., Results: The recommendations following the conference suggest the advantage of 2D vascular screening prior to cannulation and that real-time ultrasound needle guidance with an in-plane/long-axis technique optimises the probability of needle placement. Ultrasound guidance can be used not only for central venous cannulation but also in peripheral and arterial cannulation. Ultrasound can be used in order to check for immediate and life-threatening complications as well as the catheter's tip position. Educational courses and training are required to achieve competence and minimal skills when cannulation is performed with ultrasound guidance. A recommendation to create an ultrasound curriculum on vascular access is proposed. This technique allows the reduction of infectious and mechanical complications., Conclusions: These definitions and recommendations based on a critical evidence review and expert consensus are proposed to assist clinicians in ultrasound-guided vascular access and as a reference for future clinical research.

Study Objective: To present the use of ultrasonography for the performance of proximal subgluteal and distal sciatic nerve blocks in children., Design: Prospective descriptive study., Setting: University hospital., Patients: 45 ASA physical status I, II, and III patients, aged between 8 months and 16 years, scheduled for lower limb surgery., Interventions: During general anesthesia, proximal, subgluteal, and distal sciatic nerve blocks using ultrasonography were performed. If severe postoperative pain was expected, a catheter technique was used., Measurements: The injected amount of local anesthetic was noted. Based on the spread of local anesthetic, prediction for successful block was made. Complications, adverse effects, postoperative pain scores, and parent satisfaction scores were noted., Main Results: 21 proximal sciatic nerve blocks (12 single-injection and 9 continuous blocks) and 35 distal sciatic nerve blocks (17 single-injection, 6 bilateral single-injection, 4 continuous, and one bilateral continuous block) were performed. A mean initial dose of 0.25 mL.kg(-1) of ropivacaine 0.375% was injected. A successful block was obtained in all children. Excellent postoperative pain relief was obtained. All parents were satisfied with the postoperative pain relief. No complications occurred., Conclusion: Ultrasonography is useful in the identification of the sciatic nerve and it facilitates needle and catheter placement for proximal and distal nerve blocks in children., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Background: Central venous cannulation in infants remains challenging even for experienced paediatric anaesthesiologists. Ultrasound (US)-guidance techniques are proven to be safer for internal jugular vein catheterization. But the subclavian vein (SCV) is often the preferred site for long-term central venous catheterization in children. We describe a novel US-guided approach for SCV cannulation in infants and children., Methods: The principle of this technique is to place the US probe at the supraclavicular level to obtain a longitudinal view of the SCV, and to gain access to the vein via the usual infraclavicular route to cannulate it under ultrasonic control. Details and pitfalls of this technique are described. The prospectively collected results of our first 25 punctures are reported., Results: Patients' weight and age range were 2.2-27 kg and 1 day to 9 yr, respectively: 76% of the children weighed less than 10 kg. The success rate at the first attempt was 84% and 100% after two attempts. An asymptomatic thrombus in the SCV could also be detected with this technique., Conclusions: This US-guided approach of the SCV offers a new possibility for central venous catheterization in children. This technique seems promising for children less than 10 kg and probably also for older children. It provides good quality needle guidance and allows to check the vessel patency before puncture.