Are we beyond cowboy tactics for arterial catheterization?

Ultrasound guidance for vascular cannulation has been proposed to increase success rates for vascular access and decrease complications.1,2 Ultrasound is also a tool for choosing the optimal target vessel: identifying size, position, and patency is especially important under certain conditions (peripheral vascular disease, obesity, hypotension). However, studies vary by methodology, patient population, operator population, and clinical setting. The routine use of ultrasound guidance requires not only additional training and experience of the operator but also equipment availability in both elective and emergency settings.