The ASA has published its guidelines for central venous access (see link below). I am regularly amused by the slavish credence given by trainees to use of ultrasound as ‘mandatory’ for central venous access. Why I ask? That ‘s what the NICE guideline says, they reply. Do you work in the NHS I ask?
Yes ultrasound has undoubted utility for central venous access at times, and I have made good use of it. But should it be a standard of care? Are landmark-based techniques worth learning in the modern age? The ASA is much more luke-warm about ultrasound, as is the rest of the world! ‘Equivocal’ is the operative term throughout…
Studies show how useful US can be – but that is what the studies were meant to show! They were performed by enthusiastic users of a new technology.
Maybe its our colonial heritage that makes us absorb NICE (and similar) admonitions as if they were coming from a high authority to which we owe allegiance. Incidentally, the best informed UK anesthetists (several of whom with which I have worked) have many amusing things to say about the level of expertise that goes into NICE guidelines. There has also been some thoughtful discussion in recent editions of anesthesia.
Here is the ASA link in Anesthesiology.
AnaesthesiaWest 