Ultrasound Guided Vascular Access

In this lecture from our Ultrasound Grand Rounds, Dr. Matthew Tabbut, MD talks how to use ultrasound to guide vascular access.
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This is the official account of the Case Western Reserve University & MetroHealth Medical Center Emergency Medicine Ultrasound Division. Videos are not medical advice or views/policy of these institutions.

[@jennysong6078]

TY for this informative lecture! I've been struggling with ultrasound guided vascular access for difficult patients but I'm looking forward to trying it again post watching your video !

[@bettysmith4527]

The key is slow and steady wins the race!! I think we get so used to going fast when we do "blind sticks" we don't slow down when we first start doing us guidance. Slow is key!

[@MetroHealthEmergencyUltrasound]

Agreed

[@MetroHealthEmergencyUltrasound]

Your welcome! I've found that being very deliberate is the key to being successful. Let the probe guide the way for the needle. It's counterintuitive until you get used to the technique. Best of luck!

[@yuehhanlin]

Thanks that was very comprehensive. Any suggestions about applying traction for loose skin. Sometimes i run into issues puncturing the vein on older patients.

[@MetroHealthEmergencyUltrasound]

Thank you. Loose skin is less important with ultrasound. Once you get under the skin, follow the ultrasound to guide the needle to the vein. Rolling veins can be a problem. When you get the needle tip over the vein where you can see some tenting of the vein wall, give the needle a sharp pop and you can usually get the needle tip in the vein.

[@bettysmith4527]

Meh, those probe covers are around 7.00 a piece. I work on a vascular access team and we still use Tegaderms for regular PIVs without any issues. We wipe the outside of the teg with CHG once it's on the ultrasound probe and use sterile gel, and obviously clean the arm with CHG.

[@MetroHealthEmergencyUltrasound]

Yes, they are not cheap. We do not recommend tegaderms because they are not approved by the manufacturers to be used on the probe heads and they are not FDA approved as a microbial barrier. That being said, there is some interesting literature in this space that is far from definitive on the topic.