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Anaesthesiology
Vascular Access
Built from Practical Ultrasound in Anesthesia
What’s inside
5 sections · 106 slides
Overview
- What this deck covers
Why ultrasound guidance
The blind landmark technique and what ultrasound adds
- Vascular access: why it matters
- What ultrasound guidance improves
- The blind landmark technique
- What blind technique assumes
- Assumption 1-2: vein present and in position
- Assumption 3-4: vein patent and wide enough
- Assumption 5-6: landmarks clear, no collapse
Ultrasound guidance
Machine setup and cannulation techniques
- Setting the ultrasound machine
- Depth adjustment: before
- Depth adjustment: after
- Gain adjustment: before
- Gain adjustment: after
- Linear probe for vascular access
- Focus, gain, and measurement tools
- Probe orientation and the index mark
- Probe index mark: transducer notch
- Probe index mark: screen reference
- One or two operators
- Three probe orientations
- Short-axis view
- Short-axis cannulation: transducer position
- Short-axis cannulation: ultrasound image
- Long-axis view
- Long-axis cannulation: transducer position
- Long-axis cannulation: ultrasound image
- Short-axis vs long-axis
- Oblique view
- In-plane vs out-of-plane
- Four access techniques
- Vessel and needle visualisation combinations
- Short-axis out-of-plane
- Long-axis in-plane
- Short-axis in-plane
Pre-scanning protocols
RaCeVA, RaPeVA, RaFeVA, and radial artery assessment
- Why pre-scan before access
- Pre-scan protocols
- RaCeVA: rapid central vein assessment
- RaCeVA Step 1: transducer position
- RaCeVA Step 1: mid-neck short-axis view
- RaCeVA Step 2: transducer position
- RaCeVA Step 2: lower neck short-axis view
- RaCeVA Step 3: transducer position
- RaCeVA Step 3: brachiocephalic vein long-axis view
- RaCeVA Step 4: transducer position
- RaCeVA Step 4: subclavian vein long-axis view
- RaCeVA Step 5: transducer position
- RaCeVA Step 5: axillary vessels short-axis view
- RaCeVA Step 6: transducer position
- RaCeVA Step 6: axillary vein long-axis view
- RaCeVA Step 7: transducer position
- RaCeVA Step 7: lung assessment
- Six criteria for choosing the vein
- RaPeVA: rapid peripheral vein assessment
- RaPeVA Step 1: transducer position
- RaPeVA Step 1: cephalic vein in the antecubital fossa
- RaPeVA Step 2: transducer position
- RaPeVA Step 2: artery and brachial veins
- RaPeVA Step 3: transducer position
- RaPeVA Step 3: basilic vein in the bicipital groove
- RaPeVA Step 4: transducer position
- RaPeVA Step 4: nerve-vascular bundle of the arm
- RaPeVA Step 5: transducer position
- RaPeVA Step 5: cephalic vein over the biceps
- RaPeVA Step 6: transducer position
- RaPeVA Step 6: axillary vein infraclavicular view
- RaPeVA Step 7: transducer position
- RaPeVA Step 7: jugular, subclavian, brachiocephalic veins
- RaFeVA: rapid femoral vein assessment
- RaFeVA Step 1: transducer position
- RaFeVA Step 1: common femoral vessels short-axis view
- RaFeVA Step 2: transducer position
- RaFeVA Step 2: common femoral vein long-axis view
- RaFeVA Step 3: transducer position
- RaFeVA Step 3: femoral vessels and saphenous vein
- RaFeVA Step 4: transducer position
- RaFeVA Step 4: superficial and deep femoral vessels
- RaFeVA Step 5: transducer position
- RaFeVA Step 5: superficial and deep femoral vessels
- RaFeVA Step 6: transducer position
- RaFeVA Step 6: superficial femoral vessels short-axis view
- RaFeVA Step 7: transducer position
- RaFeVA Step 7: superficial femoral vessels oblique view
- Radial artery assessment
- Radial artery: transducer position
- Radial artery: short-axis view
Tips and complications
Practical tips, then detecting and managing problems
- Practical tips
- Detecting complications after access
- 2.5% → 0-0.3%
- Pneumothorax: the feared complication
- Four signs of pneumothorax
- Pleural sliding and the seashore sign
- Lung ultrasound: 2D image
- Lung ultrasound: M-mode image
- Lung pulse, A-lines, and B-lines
- Lung ultrasound: A-lines
- The lung point
- How to scan for pneumothorax
- Lung ultrasound algorithm for pneumothorax
- Arterial puncture
- Haematoma
- Conclusions and future
- Key takeaways
- References
- References (continued)
- References (continued)
- Practical Ultrasound in Anesthesia for Critical Care and Pain Management