In the United Kingdom the use of real-time ultrasound (US) is recommended for the insertion of central venous catheters (CVCs) into the internal jugular vein in adults . This is associated with decreased complications, decreased failure rates  and is possibly faster than insertion by a standard landmark technique. Concerns, however, exist regarding the training implications, cost and usefulness of these recommendations. We evaluated the effectiveness of US-guided central line insertion.
Between 1 February 2003 and 1 August 2003 we prospectively collected data regarding the use of US for CVC insertion using the Sonosite180PLUS ultrasound machine at a 14-bed general intensive care unit. All junior doctors underwent both bedside and theoretical teaching. One junior doctor underwent formal training.
Eighty-two US-guided CVCs were inserted, the majority by senior house officers (88%). Most (82%) were inexperienced with the use of US (less than 20 previous US-guided CVCs inserted), while most (81%) were experienced in non-US placement (greater than 20 previous non-US-guided CVCs inserted). Eighty-five per cent of CVCs were inserted into the internal jugular veins and 15% inserted into the femoral veins. There was a 4% failure rate. Sixty-three per cent of CVCs were inserted on the first attempt, and 21% were inserted on the second attempt. The average duration of insertion was 18 min, with 57% taking less than 15 min. There was a 10% complication rate (excluding threading of guide wire-related problems). All were minor.
US-guided CVC insertion by inexperienced junior doctors with minimal training is not only feasible, but also appears to decrease complication and failure rates as well as increasing rates of first pass insertion.
Technology Appraisal Guidance No. 49