Pitfalls of ultrasound guided vascular access: the use of three/four-dimensional ultrasound

The use of ultrasound guidance for central venous access is widespread and was recommended as the technique of choice by The National Institute of Clinical Excellence in the UK in 2002. However, complications have been reported using this technique. In this article we review the technique of two-dimensional ultrasound needle guidance and the errors that can occur. We then discuss the development of three- and four-dimensional ultrasound and describe our experiences using this imaging modality in simulated and actual needle-guidance. We discuss the potential advantages for clinicians utilising this newer form of ultrasound imaging for central venous access.