ultrasound guided intravenous cannulation · technique: the options static: find vein with us &...
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ULTRASOUND GUIDED INTRAVENOUS CANNULATION
San Emergency Ultrasound Course 2012Maggie ChungJustin Bowra
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Technique: the options Static: find vein with US & mark it, then insert cannula
blindly
Dynamic: insert cannula real-time under US guidance In-plane: see vein in in its long axis Out-of-plane: see vein in cross section
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Equipment
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IV cannulation prepas usual
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NB use a drop of local anaesthetic(the patient will thank you)
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US machine
In line of sight NB ask an assistant to drive the machine
while you’re sterile
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Machine Patient
Your handsYour eyes
ALL IN LINE
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Probe High frequency probe
Flat footprint
High resolution
But little depth
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Probe preparation
Sterile but simple
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1. Apply a layer of non-sterile gel
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2. Sterile adherent dressing
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3: Apply the dressing (Don’t squeeze out the gel!)
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Do I need more gel outside the dressing to
create an image?
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No. Pouring sterile saline on the skin will suffice.
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Identify the vein in transverse and long axes.
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Transverse (cross-sectional) view
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Longitudinal view
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A drop of local anaesthetic
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Inserting the needle
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Transverse (out-of-plane) approach
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Longitudinal (in-plane) approach
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Now for the cannula
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Are you sure we are in?
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Testing the cannulawith a saline flush
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Flow seen inside vein
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…and done.
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Top tips
• Everything lines up: machine, patient, you.• Use a long cannula if you have one• Anchor your hands on the patient• If using transverse, keep angling probe back &
forth to keep needle tip in view