Newly Published
Correspondence  |   May 2020
Practice Guidelines for Central Venous Access: Reply
Author Notes
  • University of Chicago Medical Center, Chicago, Illinois (J.L.A.). JApfelbaum@dacc.uchicago.edu
  • (Accepted for publication April 14, 2020.)
    (Accepted for publication April 14, 2020.)×
Article Information
Correspondence
Correspondence   |   May 2020
Practice Guidelines for Central Venous Access: Reply
Anesthesiology Newly Published on May 12, 2020. doi:https://doi.org/10.1097/ALN.0000000000003349
Anesthesiology Newly Published on May 12, 2020. doi:https://doi.org/10.1097/ALN.0000000000003349
Dr. Shrestha’s letter1  highlights the value of real-time or dynamic ultrasound needle guidance during central venous catheterization. Our literature and survey findings both strongly support this intervention.2 
Our evidence model did not include head position/rotation as an intervention to evaluate for a recommendation. However, if a sufficient evidence base exists (preferably randomized, controlled trials), we agree that the issue may be relevant to future updates of the Practice Guidelines for Central Venous Access. The evidence linkage would need to support the premise that an optimal degree of head rotation will minimize the chance of inadvertent carotid artery puncture.