Clinical Setting


All cannulations, ultrasound guided or otherwise, are obviously undertaken in the light of the clinical setting. The indications have been covered on page 4 of this session, however it is important to repeat that internal jugular and femoral cannulations are invasive techniques, not without risk of harm, and should have adequate justification.


These invasive techniques can be used in children [8,9] and ultrasound guided femoral cannulation can be rapid and extremely helpful in the very sick child. The groin is often readily available while the neck is not (due to airway manoeuvres).


Consent should always be undertaken and, in the relatively critical context of the emergency department (ED), will usually be verbal. It is wise to document ‘verbal consent obtained’ in the notes before starting.

Competent Use

The competent use of ultrasound will always make internal jugular and femoral cannulations safer. We have already stated that its use:

Decreases complications
Increases the first-time success of line placement
Decreases the number of efforts required
Decreases the overall time spent carrying out the technique

In addition, it results in a successful cannulation in otherwise difficult cases.