Combining Infrared Vein Visualization and Ultrasound Guidance for Central Line Placement in Difficult Venous Access Patients: A Technical Report.

Central venous catheterization (CVC) is an essential critical care procedure with many indications, such as dialysis, medication administration, and hemodynamic monitoring. However, it can be challenging to perform in specific patient groups, particularly in those with obesity or in oncologic patients. The gold standard technique for CVC is ultrasound guidance (USG), which is a superior method to the traditional landmark-based approach as it reduces the rate of complications such as pneumothorax or arterial puncture. Despite being the gold standard, the ultrasound-guided approach may present technical challenges for deeper vessels in certain patients, such as those with significant obesity due to poor acoustic windows. Infrared vein visualization (IVV) is a known technique commonly used for superficial vein mapping and peripheral venous access. This technical report explores the combined use of IVV and USG for CVC placement. It aims to optimize vein localization and reduce procedural difficulties, particularly in patients with anticipated vascular access challenges due to factors such as obesity or prior unsuccessful catheterizations. The proposed theoretical approach involves pre-procedural vein mapping with IVV, followed by real-time USG for catheter insertion, particularly in patients with obesity. Although IVV alone has limited utility in such patients due to its shallow penetration depth, its use as a complementary tool for pre-procedural mapping followed by ultrasound-guided cannulation may enhance CVC placement in this population by improving site selection and reducing failed attempts. Further clinical studies are required to assess the efficacy and cost-effectiveness of this approach.