Sonography Guidance for Central Venous Access

This is a short presentation on the use of sonography for procedural guidance and vascular access, those peripheral and central. You want to start with a Linear Probe which is a flat probe, high frequency, 3 - 12 megahertz. Identify the indicator which is a bumper grove on the side. Put a little bit of gel on there and make sure that the indicator corresponds to the left side of the screen as it is viewed. That will be your orientation for looking at vessels.

Vessels can be either in the short or the long axis. The long axis in plane, the short axis is out of plane. This is a short axis clip of a peripheral vessel. So you see the collapse ability of the vein, the indicator is to the left side of the screen which is the left of the patient as you're looking up.

This is showing the application of the Linear Probe to the neck of a patient around the area that you would look for the internal jugular access. The indicator in this case is to the patient's right and the fingers placed right here over the vessel as it's going into the neck. When this is done you should be able to see the internal jugular vein lateral to the Carotid Artery. Here is a short clip showing collapse of the internal jugular lateral to the Carotid, the Trachea shown medial to this.

When you're doing a central access procedure you need to use sterile precautions, this shows the application of a sterile probe cover. The gel which doesn't need to be sterile inside is placed inside the probe cover and the probe is then lowered into this cover and allowed to fall down without touching anything creating a sterile probe cover that can then be used for central vascular access.

Here we're putting rubber band and some sterile gel on top of the probe. Once this is done you could use it for central venous access. Again when you're looking at a needle you can look at it in the in plane approach or the outer plane approach. The indicator is identified here to my left and I'm using the use of a middle in the short axis or out of plane approach.