Real-time three-dimensional ultrasound-guided central venous catheter placement.

We present the first description of real-time 3-dimensional ultrasound for insertion of a central venous catheter in a surgical patient. An HD11 XE™ ultrasound machine with a V8-4 transducer (Philips Medical Systems, Bothell, WA) was used throughout. Three-dimensional multiplanar and volume-rendered views allowed us to simultaneously view the neck anatomy in 3 orthogonal planes. Needle entry into the vein and subsequent catheter placement were also visualized. We were able to rotate the views in real time, thereby enabling visualization of the catheter within the lumen of the vein. The ability to see simultaneous real-time short- and long-axis views along with volume perspective without altering transducer position is an exciting development with the potential to confer a safety benefit to the patient. Although the operator is required to assimilate more information, the limitations we encountered were mainly related to processing power and transducer size, which we expect will be overcome with advancing technology.