Techniques
Ultrasound Guidance
Equipment
- Two pairs of sterile gloves
- Mask
- Sterile gown
- Skin-preparation solution (e.g. chlorhexidine)
- Sterile drain
- 1% lidocaine (no adrenaline), 5mL syringe and 25 guage needle
- Angiocatheter
- Sterile probe cover and sterile gel
- Sterile gauze
- Dressing
- Pressure bag
- Pressure transducer
- Monitor
- Linear probe
Method
- Wash hands and put on mask
- Position the forearm so that it is flat
- Put on sterile gloves
- Use antiseptic solution to wash skin from the wrist to antecubital fossa
- Discard sterile gloves
- Wash hands again
- Put on gown
- Put on sterile gloves
- Drape the patient exposing only the clean area from the wrist to the antecubital fossa
- Have an assistant clean the USS with a antiseptic wipe
- Cover the USS probe in a sterile manner with the ultrasound probe cover
- Remove air pockets around the probe and secure with rubber bands
- Determine orientation of the probe
- Scan the wrist looking for calcification, kinking and pulsatility
- Have an assistant adjust the gain and depth
- Anaesthetise the skin
- Insert the angiocatheter at a 45-60° angle to the skin
- Slide or tilt the probe towards the needle until you can visualise the tip
- As you advance the needle towards the artery, tilt the probe in the direction of the needle’s trajectory
- Insert into the artery and observe for flushback
- Flatten the catheter and ensure with ultrasound that the needle tip is still within the artery
- Slide the catheter over the needle into the atrterial lumen
- Apply pressure proximal to the needle and attach the catheter to the transducer
- Apply a sterile dressing
Over the Wire
Under the Wire
Sources