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
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
Equipment
IV cannulation prepas usual
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NB use a drop of local anaesthetic(the patient will thank you)
US machine
In line of sight NB ask an assistant to drive the machine
while you’re sterile
Machine Patient
Your handsYour eyes
ALL IN LINE
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.
Identify the vein in transverse and long axes.
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Transverse (cross-sectional) view
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Longitudinal view
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.
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