Role of Ultrasound Guidance for Central Venous Access, Chest Tube Insertion, and Interventional Management of Cholecystitis in ICU Patients

  • Steven M. YevichEmail author
  • Rahul A. Sheth
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)


Ultrasound guidance has been advocated as a method to potentially improve percutaneous treatment success and reduce complication rates associated with traditional surgical approaches. Procedural applications for the cardiothoracic critical care surgical patient include central venous access, insertion of chest tubes, and management of cholecystitis. The use of realtime ultrasound in central venous access has received high grade recommendations for the reduction of procedural complications, with impact more apparent in the access of the internal jugular vein compared to the subclavian or femoral veins. In the treatment of pneumothorax and pleural fluid collections, the ultrasound placement of small bore drains has similar outcomes to the conventional insertion of large bore drains placed via blunt dissection by the available low level evidence. The treatment of cholecystitis in the ICU patient by ultrasound guided gallbladder aspiration or cholecystostomy tube placement has low quality evidence to suggest a high technical success rate and low immediate procedural complication rate, despite procedural technical variability. While these ultrasound guided techniques appear to provide a safe treatment alternative to urgent or emergent cholecystectomy in the high risk patient, low level evidence suggests use as a temporizing treatment to shortly thereafter bridge for cholecystectomy.


ICU Ultrasound Central venous access Chest tube Thoracostomy Gallbladder aspiration Cholecystostomy Laparoscopic cholecystectomy 


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.University of Texas MD Anderson Cancer CenterHoustonUSA

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