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Richard Hay
Procedural Ultrasound
Aim
Provide an overview of uses and techniques
Why
When
How
Advantages and disadvantages
Basic tips
Ultrasound Guided Procedures
Vascular access
Central, Peripheral, Arterial
Aspiration
Thoracocentesis
Paracentesis
Pericar...
Why use Ultrasound for Procedures
Allows visualisation of anatomy prior to an invasive
procedure
Detect abnormal anatomy
I...
Basic Ultrasound Knowledge for Learning
Procedural Ultrasound
Choice of probe
Field of view
Frequency
The ultrasound beam
...
Basic Ultrasound Knowledge for Learning
Procedural Ultrasound
The ultrasound image
What the needle looks like
Transverse
C...
Procedural Techniques
Methods
Indirect approach
Mark the spot
Direct approach
Real time
Transverse (out of plane)
Longitud...
Procedural Techniques
Indirect approach
Best for
Large static targets not too far away
Ascites
Pleural effusion
Small supe...
Indirect approach
Technique
Locate target with US and identify best site for skin
entry
Measure size and depth
Observe for...
Indirect approach
Advantages
Quick
Easy
Less coordination required
Less experience required
No requirement for sterile tra...
Indirect approach
Disadvantages
Not under direct vision
Not good for small distant targets
Patient must not move between m...
Procedural Techniques
Direct method
Needle is advanced under direct US vision
Two different approaches
Transverse
Target i...
Transverse Approach
Procedural Techniques
Direct method
Needle is advanced under direct US vision
Two different approaches
Transverse
Target i...
Longitudinal Approach
Transverse approach
Indications
Two or more parallel structures that appear similar
when seen in longitudinal section
Not ...
Transverse approach
Technique
Target in center of US image
Note depth of target
Needle in line with midpoint of transducer...
Transverse approach
Advantages
Can see and avoid structures either side of the
target
Can use a steeper angle of approach
...
Transverse approach
Disadvantages
Needle harder to see in cross section
Often rely on just the tissue movement
Depth of ne...
Longitudinal approach
Indications
Small targets requiring precise needle placement
Peripheral vascular access
Nerve blocks...
Longitudinal approach
Technique
Identify target in transverse then go to longitudinal
view
Note depth of target
Consider n...
Longitudinal approach
Advantages
Better localisation of needle
Visually striking
Watch needle all the way to the target
Ca...
Longitudinal approach
Disadvantages
Difficult to line up three objects
US beam, needle, target
Requires more
Coordination
...
Longitudinal approach
Disadvantages
Difficult to line up three objects
US beam, needle, target
Requires more
Coordination
...
Procedural Ultrasound
General Comments
Positioning
Ensure patient and operator comfortable
Line up
Patient, target and tra...
Procedural Ultrasound
General Comments
Positioning
Ensure patient and operator comfortable
Line up
Patient, target and tra...
Procedural Ultrasound
General Comments
Vein vs artery
Veins
Thin walls, compress, respiratory variation, valsalva, triple
...
Procedural Ultrasound
General Comments
Vein vs artery
Veins
Thin walls, compress, respiratory variation, valsalva, triple
...
Procedural Ultrasound
Summary
Ultrasound is useful for many procedures
Improved safety and success
Basic ultrasound knowle...
Introduction to procedural ultrasound
Introduction to procedural ultrasound
Introduction to procedural ultrasound
Introduction to procedural ultrasound
Introduction to procedural ultrasound
Introduction to procedural ultrasound
Introduction to procedural ultrasound
Introduction to procedural ultrasound
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Introduction to procedural ultrasound

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Introduction to procedural ultrasound

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Introduction to procedural ultrasound

  1. 1. Richard Hay
  2. 2. Procedural Ultrasound Aim Provide an overview of uses and techniques Why When How Advantages and disadvantages Basic tips
  3. 3. Ultrasound Guided Procedures Vascular access Central, Peripheral, Arterial Aspiration Thoracocentesis Paracentesis Pericardiocentesis Joint aspiration Supra-pubic aspiration Foreign body detection and removal Nerve blocks
  4. 4. Why use Ultrasound for Procedures Allows visualisation of anatomy prior to an invasive procedure Detect abnormal anatomy Identify interposed structures Better localisation of target Prevent invasive procedure being attempted when not indicated
  5. 5. Basic Ultrasound Knowledge for Learning Procedural Ultrasound Choice of probe Field of view Frequency The ultrasound beam Slice thickness and beam width The ultrasound image Fluid is black Soft tissues are grey Air and metal hyperechoic and cause reverberation Bone and stones cause shadowing
  6. 6. Basic Ultrasound Knowledge for Learning Procedural Ultrasound The ultrasound image What the needle looks like Transverse Comet tail artifact Beam width artifact Longitudinal Reverberation artifact Size and depth measurement
  7. 7. Procedural Techniques Methods Indirect approach Mark the spot Direct approach Real time Transverse (out of plane) Longitudinal (in plane)
  8. 8. Procedural Techniques Indirect approach Best for Large static targets not too far away Ascites Pleural effusion Small superficial targets
  9. 9. Indirect approach Technique Locate target with US and identify best site for skin entry Measure size and depth Observe for changes with respiration Note midpoint and axial direction of transducer Remove transducer and mark skin Perform procedure
  10. 10. Indirect approach Advantages Quick Easy Less coordination required Less experience required No requirement for sterile transducer cover
  11. 11. Indirect approach Disadvantages Not under direct vision Not good for small distant targets Patient must not move between marking and procedure
  12. 12. Procedural Techniques Direct method Needle is advanced under direct US vision Two different approaches Transverse Target in transverse section in center of image Needle approach is perpendicular to the scan plane
  13. 13. Transverse Approach
  14. 14. Procedural Techniques Direct method Needle is advanced under direct US vision Two different approaches Transverse Target in transverse section in center of image Needle approach is perpendicular to the scan plane Longitudinal Target in longitudinal section across image Needle approach is along the scan plane
  15. 15. Longitudinal Approach
  16. 16. Transverse approach Indications Two or more parallel structures that appear similar when seen in longitudinal section Not enough room for longitudinal approach
  17. 17. Transverse approach Technique Target in center of US image Note depth of target Needle in line with midpoint of transducer a few centimeters away Slowly advance needle and watch tip by: Fanning transducer toward needle and back to target Jiggle needle to move soft tissues Beware not to advance needle beyond the scan plane
  18. 18. Transverse approach Advantages Can see and avoid structures either side of the target Can use a steeper angle of approach Less space at anatomical site required
  19. 19. Transverse approach Disadvantages Needle harder to see in cross section Often rely on just the tissue movement Depth of needle difficult to assess Sterile transducer cover required
  20. 20. Longitudinal approach Indications Small targets requiring precise needle placement Peripheral vascular access Nerve blocks Biopsy
  21. 21. Longitudinal approach Technique Identify target in transverse then go to longitudinal view Note depth of target Consider needle trajectory and desired target entry point Needle in line with midpoint of long axis of transducer Slowly advance needle under direct vision Angle corrections required to keep needle in line with scan plane
  22. 22. Longitudinal approach Advantages Better localisation of needle Visually striking Watch needle all the way to the target Can see structures deep and superficial to the target
  23. 23. Longitudinal approach Disadvantages Difficult to line up three objects US beam, needle, target Requires more Coordination Practice Cannot see structures either side of target Two adjacent parallel structures can look similar Easy to slip from one to the other
  24. 24. Longitudinal approach Disadvantages Difficult to line up three objects US beam, needle, target Requires more Coordination Practice Cannot see structures either side of target Two adjacent parallel structures can look similar Easy to slip from one to the other More space required at anatomical site Shallow approach angle Transducer longitudinal
  25. 25. Procedural Ultrasound General Comments Positioning Ensure patient and operator comfortable Line up Patient, target and transducer, screen Watch the screen not your hands
  26. 26. Procedural Ultrasound General Comments Positioning Ensure patient and operator comfortable Line up Patient, target and transducer, screen Watch the screen not your hands Use the transducer to find the needle Make sure local anaesthetic is free of air
  27. 27. Procedural Ultrasound General Comments Vein vs artery Veins Thin walls, compress, respiratory variation, valsalva, triple pulsation Arteries Round, thicker wall, single pulsation
  28. 28. Procedural Ultrasound General Comments Vein vs artery Veins Thin walls, compress, respiratory variation, valsalva, triple pulsation Arteries Round, thicker wall, single pulsation Nerves View in transverse Needle along scan plane
  29. 29. Procedural Ultrasound Summary Ultrasound is useful for many procedures Improved safety and success Basic ultrasound knowledge required A number of different techniques Suit different circumstances Learned skill Practice

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