Ultrasound-guided arterial catheterization: a narrative review

Arterial catheterization is the second most common invasive procedure performed in the intensive care unit. Despite the ubiquity of the procedure, complications including failure to place the catheter occur. While many clinicians are familiar with the use of ultrasound (US) guidance to decrease complication rates of central venous catheter insertion, fewer are familiar with the use of ultrasound to guide arterial catheterization. This manuscript reviews the evidence for the utility of ultrasound for this indication. Technical aspects of the procedure and limitations of the existing evidence are reviewed. A description of the procedure is provided, along with an online supplemental video. Most studies indicate that first-pass success will be improved with US-guided (USG) arterial catheterization. The technique is easy to learn, particularly if one is already familiar with USG for central venous catheter placement. More research, including formal analyses of cost effectiveness, is needed.