Ka ccm eus fundamentals

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  • Can decrease overall resolution
  • Remember high frequency give you better resolution (images) but has poor penetrationinto the tissue (need to focus on superficial structures).
  • If you apply enough pressure you WILL compress an artery (but less than the nearby vein)
  • Remember: The carotid is medial to the IJ. The probe marker is to YOUR left for venous access. If this is the right side of the neck then the carotid will be the small round structure slightly left and inferior to the large round IJ
  • Why is this important? This is important because if you are too far below the inguinal ligament the femoral artery will likely partially overlap the vein in at least half of the population
  • Ka ccm eus fundamentals

    1. 1. Ultrasound Fundamentals Kiyetta Alade, M.D., RDMS Assistant Professor Director, Pediatric Emergency Ultrasound Section of Emergency Medicine Department of Pediatrics Baylor College of Medicine Texas Children’s Hospital Pediatrics
    2. 2. Gain •Gain: Adjusts the intensity of returned echoes shown on display ‐Increasing gain makes picture brighter Page 2Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    3. 3. Gain Gain will amplify all returning echoes equally Page 3Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    4. 4. Gain Page 4Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    5. 5. Ultrasound Fundamentals •Depth: Can be adjusted to ensure entire structure of interest is on the screen Page 5Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    6. 6. Depth Page 6Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    7. 7. Gain / Depth Page 7Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    8. 8. Ultrasound Fundamentals •Axial resolution: US machines ability to differentiate objects in plane parallel to traveling wave ‐Increase frequency or decrease wavelength to improve •Lateral resolution: US machine’s ability to differentiate objects in plane perpendicular to traveling wave Page 8Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    9. 9. Resolution Axial Lateral Page 9Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    10. 10. Resolution •Low resolution (2-4 MHz) ‐Lower frequency ‐Deeper penetration •High resolution (8-14 MHz) ‐High frequency ‐Poor penetration (best to image superficial structures) Page 10Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    11. 11. Probe Selection •High frequency •Low frequency ‐Linear Array ‐Curvilinear ‐Phased array Page 11Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    12. 12. Ultrasound Fundamentals •Every probe has raised marker to correlate with the side of the screen with some type of identifier (dot, logo) Page 12Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    13. 13. Probe Marker Page 13Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    14. 14. User Orientation •Remember the probe marker correlates with the symbol on the screen Page 14Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    15. 15. User Orientation Page 15Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    16. 16. User Orientation •Objects near the top of the screen correlate with structures CLOSEST to the probe on the patient •Objects near the bottom of the screen correlate with structures furthest away from the probe on the patient Page 16Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    17. 17. User Orientation Probe BED Page 17Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    18. 18. Ultrasound Fundamentals •D (doppler) mode: Senses the movement of reflected US waves toward and away from the probe by color change or sound ‐Color represents flow toward or away from probe… NOT arterial vs venous flow ‐(Blue Away Red Toward) Page 18Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    19. 19. Color Doppler Page 19Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    20. 20. Procedural •Static ultrasound locates •Dynamic ultrasound is structure of interest but used to locate structure not used to guide of interest AND allow procedure direct visualization of ‐LP procedure in real time ‐Thoracentesis ‐Vascular access ‐Paracentesis ‐I&D Page 20Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    21. 21. Probe Selection •4-10 MHz frequency •Linear Array •Small to medium footprint Page 21Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    22. 22. Vessel Selection Vein Artery •Thin walled •Non compressible •Compressible •Pulsating •May have transmitted pulsations from nearby arteries Page 22Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    23. 23. Vessel Selection •Must be able to differentiate arteries from veins ‐Compression (veins more compressible) ‐Distal Augmentation ‐Color flow (look for pulsations) Page 23Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    24. 24. Screening Ultrasound •Before preparing to cannulate a vessel you should ‐Screen the area of interest for a target ‐Evaluate the vessel size ‐Evaluate vessel compressibility Page 24Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    25. 25. Screening Ultrasound •Before preparing to cannulate a vessel you should ‐Ensure you are targeting the correct vessel ‐Measure the depth Page 25Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    26. 26. Compression IJ CA IJ CA Page 26Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    27. 27. Distal Augmentation Page 27Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    28. 28. Transverse Approach to Vessel Page 28Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    29. 29. Transverse Approach •With a transverse approach to vessel puncture you should orient the probe with the marker to YOUR left and the US screen in FRONT of you ‐This allows for easy manipulation ‐If on the screen the needle looks like it is to the right of the vessel then you change direction more to the left Page 29Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    30. 30. Transverse Approach •Locate target vessel in transverse plane •Pucture skin adjacent to probe, locate needle tip and follow it until it enters vessel ‐This requires you to move the probe as you advance the needle (following the needle tip) Page 30Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    31. 31. Transverse Approach Page 31Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    32. 32. Transverse Approach Page 32Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    33. 33. Transverse Approach •Able to visualize surrounding structures •Have to locate needle tip through motion or comet artifact Page 33Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    34. 34. Longitudinal Approach to Vessel Page 34Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    35. 35. Longitudinal Approach •Locate target vessel in transverse approach •Turn probe longitudinal over selected vessel (probe marker to patients head) •Puncture skin adjacent to probe •Advance needle DO NOT move probe •Keep vessel in screen Page 35Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    36. 36. Longitudinal Approach Page 36Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    37. 37. Longitudinal Approach Page 37Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    38. 38. Internal Jugular Page 38Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    39. 39. Internal Jugular •Position the ultrasound screen in front of you •Orient the ultrasound probe with marker to YOUR left ‐This allows you to move the probe in the SAME direction as visualized on the screen Page 39Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    40. 40. Internal Jugular Central Line carotid Page 40Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    41. 41. Valsalva Page 41Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    42. 42. Internal Jugular Central Line •US guided central line placement still with complications (fewer than landmark technique) ‐Puncture of posterior wall of vein ‐Cannulation of carotid artery Page 42Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    43. 43. Femoral Vein •Complete overlap of femoral artery over vein 4 cm below inguinal ligament about half of the time •At least 50% overlap of femoral artery over vein in same location Hughes, et al. Brit J Anes. Ultrasonography of the43 Page femoral vessel in the groin: implicationsPediatricsfor vascular access. 2000:84(5):668-669 xxx00.#####.ppt 7/10/2012 8:55:32 AM
    44. 44. Femoral Vein Page 44Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    45. 45. Femoral Vein •Position the ultrasound screen in front of you •Orient the ultrasound probe with marker to YOUR left ‐This allows you to move the probe in the SAME direction as visualized on the screen Page 45Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    46. 46. Femoral Vein •Single operator: ‐Hold probe with hand on outside of leg •Left hand right leg •Right hand left leg ‐Use free hand to access vein using Seldinger technique Page 46Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    47. 47. Femoral Vein •Locate target vessel in transverse plane •Measure depth of vessel •Puncture skin at a ~ 30° angle (too sharp will inhibit passing of guidewire) Page 47Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    48. 48. Sonosite M-Turbo Series Page 48Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    49. 49. Our Probes Phased Array Neonatal Linear Page 49Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    50. 50. Page 50Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    51. 51. Select your probe Page 51Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM
    52. 52. Thank You Page 52Pediatrics xxx00.#####.ppt 7/10/2012 8:55:32 AM

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