Pediatric emergency medicine trisk 4513 4513
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FIGURE 131.22 Femoral artery and vein.
When using ultrasound dynamically, a one- or two-person approach can be
used. The two-person technique may be easier for the inexperienced ultrasound
user. In this scenario, one person is responsible for holding the probe and keeping
the vein centered on the screen. The proceduralist can then focus his or her
attention on the patient, the site of puncture, and the ultrasound screen, without
having to hold the probe. In the one-person approach, the proceduralist holds the
probe in the nondominant hand and inserts the needle with the dominant hand.
This requires more technical skill, but ultimately allows for improved awareness
regarding needle tip location and more fine-tuned adjustments.
As the procedure begins, the vein is reidentified and centered in the screen. In
the dynamic technique, the transverse view is commonly used because it allows
visualization of not only the intended vein, but also the nearby arteries and nerves
in cross section (Fig. 131.22 ). This short-axis approach is more successful for the
novice user and should be the method of choice for beginners. Alternatively, the
vasculature can be identified in the longitudinal plane. The long-axis approach is
more difficult and requires greater skill; however, for the experienced
sonographer, this view offers the advantage of visualizing the vein (and thus
needle and catheter) along its entire course of cannulation ( Video 131.24 ).
