I have a couple of anecdotes to share. I was called to insert a line in an obese patient with idiopathic thrombocytopenic purpura (also called immune/autoimmune thrombocytopenic purpura or ITP). The patient’s platelet count was 2,000. Despite the short, bulky neck, a physician assistant (PA) who had done only 20 previous internal jugular sticks, accessed the vein on the first attempt using ultrasound guidance and there were no complications.
We were called to insert a central line in a morbidly obese man (see photos) who was hypotensive. A PA who had done fewer than 10 previous central line insertions successfully cannulated his right internal jugular vein on the first try using ultrasound.
I was skeptical regarding ultrasound for vascular access for years. Now I would not insert a central venous catheter without using it.