Procedural Ultrasound
Acquisition
The Scans
PIV
CVC
Paracentesis
Thoracentesis
Pericardiocentesis
Arthrocentesis
Lumbar Puncture
PIV
Indications
Failed traditional access
Limited options
Hx of difficult Stick
Acquisition
Use compression to ID Vein
Look for surrounding arteries and nerves and other structures to avoid
NALTA to vessle
Ensure catheter is appropriate gauge and length for target vessel
CVC
m
Indications
Failed traditional access
Limited options
Hx of difficult Stick
Long term pressors
Hemodialysis
Plasma Exchange
Certain medications (23% Sodium)
Acquisition
Use compression to ID Vein ( ensure entire length without clot)
Look for surrounding arteries and nerves and other structures to avoid
NALTA to vessel
Paracentesis
Indications
Ascites: diagnostic vs therapeutic
Acquisition
Visualize fluid pocket
Measurements for depth
Confirm NO bowel
Confirm location of epigastric arteries
Choose best location: RLQ or LLQ
Patient positioning- should not change from scan to poke
Curvilinear
Switch to linear for evaluation of epigastric arteries
Can use phase for ultrasound assisted, but difficult for guided procedure
Thoracentesis
Indications:
Pleural effusion: diagnostic or therapeutic
Acquisition
Visualize fluid
Confirm location of diaphragm and liver/spleen
Basic characterization of fluid
Choose best location
Deepest pocket
Up and over rib
Patient positioning
Probe choice: curvilinear
Pericardiocentesis
Indication
Pericardial Effusion: hemodynamic compromise
Acquisition
Visualize fluid
Patient positioning: supine
Location with fluid closest to transducer and greatest depth
Transthoracic near apex
Usually SUX or PLAX views, sometimes A4C
Make sure the heart doesn’t swing into needle path
Phased array or curvilinear
Arthrocentesis
Indication
Aspiration of joint effusion: therapeutic or diagnostic
Joint injection
Visualization of joint/anatomy
Acquisition
Visualize fluid
Patient positioning to open joint (depending on joint and effusion)
Usually in plane
Lumbar Puncture
ultrasound assisted *
Indication
Obtain CSF: diagnostic or therapeutic
US guidance:
Body habitus limits landmark technique
Multiple failed attempts
Concern for bony abnormalities (DDD, scoliosis)
Acquisition
Patient positioning
Identify and mark on patient
Spinous process
Midline
Usually Curvilinear Probe for increased field of view
