In-Plane vs Out-of-Plane Approach

The plane of the sonography cuts across the shaft to the needle. We can rotate this to an in plan approach where the needle is in the plane of the ultrasonography. The advantage of this is that you can see the entire tip of the needle. However, the out of plane approach is a little bit better for centering the needle over the vessel of interest.

This shows a target a sign which is what you want to see when you're accessing something in a short axis or out of plane; you can see the needle on the center of vessel. Here again is a short axis procedure where we are accessing the internal jugular. You can see the Endothelium kind of tempting into the internal jugular vein there and we are across or out of plane with the transducer in that particular clip.

Here is an in plane or long axis procedure where the needle is being inserted into the internal jugular vein. You can see the tip and again we're showing this as it would occur in a peripheral vein. You can see the tip of the needle entering the vessel and then we thread the Catheter.

You can check that the Catheter has been threaded by placing the sonography on there. Here we can actually see a Catheter in peripheral vessel. The other thing that you can do is flush the Catheter. Here's we're actually following the wire for central venous access into the IJ. When you flush the Catheter, just take some agitated saline when injected and you can see bubbles through the vessel.