HARD DECISIONS IN INTENSIVE CARE UNIT

Intensivecareunitkapak

USG-GUIDED PROCEDURES IN INTENSIVE CARE UNIT

Orhun Demir

Lokman Hekim University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Ankara, Türkiye

Demir O. USG-Guided Procedures in Intensive Care Unit. In: Turan S, editor. Hard Decisions in Intensive Care Unit. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.459-469.

ABSTRACT

Ultrasound is widely used in intensive care units to provide guidance during interventional procedures and to facilitate diagnostic processes. Its advantages include portability, quick results, lack of radiation, and low cost, whereas its disadvantages include operator dependency and patient-related factors. The central venous catheter placement procedure is frequently performed under ultrasound guidance in intensive care. Using ultrasound increases the first-attempt success rate and overall success while reducing complications. Similarly, it has been noted to improve success rates and reduce complication risks in radial and femoral artery cannulations. Although convex probes may be necessary for morbidly obese patients, high-frequency linear probes are typically used for these procedures, when targeting the femoral vein. Ultrasound-guided vascular techniques may reduce catheter-related bloodstream infections due to advantages such as fewer interventions, shorter procedure time, and the use of appropriate sterile techniques. Pericardiocentesis under ultrasound guidance is preferred due to its high success rate and low risk of complications. The nature of the effusion and surrounding structures is carefully evaluated during the procedure. Intercostal or subcostal approaches are performed under sterile conditions, and lung sliding should be checked after the intercostal approach. Ultrasound guidance in pleural effusions helps reduce complications, such as pneumothorax and ensures high success. Thoracentesis can be performed using static or real-time ultrasound guidance. Prior to the procedure, effusion characteristics and target area are thoroughly examined, and drainage is performed using static or dynamic techniques. Paracentesis under ultrasound guidance ensures the successful drainage of free peritoneal fluid and reduces risk of complications. Free peritoneal fluid is commonly observed in ICU patients, especially in cases of small fluid collections or obesity, where real-time ultrasound guidance is recommended. Ultrasound guidance during lumbar puncture reduces the number of attempts required and minimizes risk of complications, particularly in cases of anatomical challenges. Post-procedural complications may include post-dural puncture headache, traumatic puncture, bleeding, infection, cerebrospinal fluid leakage, dural injury, and allergic reactions. Ultrasound plays a crucial role in diagnostic and therapeutic processes in ICU settings by, effectively reducing complications and improving procedural success rates.

Keywords: Intensive care units; Ultrasonography; Interventional; Vascular access devices; Complication; Spinal puncture

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