This course teaches healthcare professionals to place a catheter successfully inside a peripheral vein or an artery using ultrasound

You will learn the theory of ultrasound guided vascular access using the DNTP technique, 6 exercises that will train your practical skills needed for performing the procedures, and suggestions for how to perform selected patient procedures

The course is relevant for all healthcare professionals
– No matter who you are
– No matter where you are
– No matter the size of the vessel
– No matter if it is a vein or an artery

The procedures shown are used at your own risk and USabcd can take no responsibility for any hazards of procedures performed by yourself

It is necessary to know about blood vessel anatomy of the upper and lower limbs in order to find the relevant blood vessels for ultrasound guided vascular access

Now you will learn about:

– The preferred veins and arteries for ultrasound guided vascular access in the upper and lower limbs
– The appearance of blood vessels in longitudinal and cross-sectional view
– How to identify arteries and veins in the cross-sectional view on the ultrasound screen
– How to estimate the diameter of the target vessel
– How to estimate the skin-vessel distance
– How to estimate the optimal length of the vascular catheter

Venous catheterisation is used for peripheral venous catheters, blood sampling and blood donation.

In the upper limb, veins distal to the elbow are preferred including the cubital vein and the network of veins distal to the antecubital fossa. If attempting the access the cubital vein, be sure to identify the brachial artery and median nerve first, to avoid accidental arterial puncture or neddle insertion into the nerve (very painful)

In the lower limb, veins at the level of the ankle or distal to the ankle are preferred. The major saphenous vein can also be used

Basilic and cephalic veins: Normally the brachial and cephalic veins proximal to the antecubital fossa should be avoided. Under special circumstances (midline/PICC-line), both the cephalic and basilic veins may be used.

Ultrasound guided vascular access is a clinical skill, and is learned by a combination of theory and practical training

This lesson will take you through the necessary elements for performing peripheral ultrasound guided vascular access and after the lesson you will be able to practice the technique in different procedures in your patients. Elements included are:

– Ultrasound theory
– The Dynamic Needle Tip Positioning (DNTP) technique
– A guide to hands-on exercises that will get you the technique into your hands
– Demonstration of standard procedures for different vascular procedures

In the epigastrium in the horizontal view, the aorta and inferior vena cava (IVC) are seen in cross section on top of the vertebral column (VC)

– Select an initial depth of 15-20 cm

– Identify the black, pulsatile aorta and the black, compressible IVC on top of the VC. The VC is seen as a curved hyperechoic (white) line with a black acoustic shadow. Often, the compressible ICV is also pulsatile due to pressure waves from the right ventricle and right atrium

– Align the aorta to the center of the monitor and adjust the depth.

– If the view is obscured by intestinal gas use steady pressure with the probe to displace the intestinal loops/gas or displace and tilt the probe until you get a view without gas.

The diameter of the abdominal aorta is measured as the diameter in the anterior-posterior direction from outside surface to outside surface. A pitfall is to measure the visible lumen of an aneurysm instead of the outer diameter.

An aneurysm is a localised dilatation of the aortic diameter 150% of the normal diameter i.e. exceeding 30 mm.

Generally 50 to 55 mm is the cut-off point above which patients with asymptomatic aortic aneyrisms are offered surgery.

Abdominal aortic aneurysms always have wall thromboses.

NOTE: It is very difficult to identify the vessel rupture or

The diameter of the abdominal aorta is measured in the anterior-posterior direction from outer wall to outer wall.

Usually the boundary to the surrounding tissue is more clearly visible in the anterior-posterior direction compared to the left-right measurement.

The normal diameter of the abdominal aorta is approximately 20 mm.

In the longitudinal view the superior mesenteric artery is seen to branch off the abdominal aorta just below the celiac trunk.

The survival of patients with imminent rupture of the abdominal aorta is critically dependent on the time-effectiveness of the diagnosis.

The learning objectives of this module are:

– to be able to identify the normal sonoanatomy of the abdominal aorta

– to be able to diagnose an abdominal aneurysm in an unstable patient with severe
abdominal pain

– Place the patient supine

– Select a curved array probe (abdominal) or a phased array probe (cardiac)

– Place the probe at the top of the epigastrium and scan from the epigastrium down to the aortic bifurcation keeping the probe in the midline

– First view is the cross sectional plane. When you reach the bifurcation rotate the probe clockwise and scan with a longitudinal view from bifurction to the xiphoid process.