1

ULTRASOUND GUIDED INTRAVENOUS CANNULATION

San Emergency Ultrasound Course 2012Maggie ChungJustin Bowra

Technique: the options Static: find vein with US & mark it, then insert cannula

blindly

Dynamic: insert cannula real-time under US guidance In-plane: see vein in in its long axis Out-of-plane: see vein in cross section

Equipment

IV cannulation prepas usual

5

NB use a drop of local anaesthetic(the patient will thank you)

US machine

In line of sight NB ask an assistant to drive the machine

while you’re sterile

Machine Patient

Your handsYour eyes

ALL IN LINE

Probe High frequency probe

Flat footprint

High resolution

But little depth

9

Probe preparation

Sterile but simple

10

1. Apply a layer of non-sterile gel

11

2. Sterile adherent dressing

12

3: Apply the dressing (Don’t squeeze out the gel!)

13

14

Do I need more gel outside the dressing to

create an image?

15

No. Pouring sterile saline on the skin will suffice.

Identify the vein in transverse and long axes.

17

18

Transverse (cross-sectional) view

19

Longitudinal view

A drop of local anaesthetic

21

Inserting the needle

23

24

Transverse (out-of-plane) approach

25

Longitudinal (in-plane) approach

26

Now for the cannula

28

29

Are you sure we are in?

30

Testing the cannulawith a saline flush

31

Flow seen inside vein

32

…and done.

Top tips

• Everything lines up: machine, patient, you.• Use a long cannula if you have one• Anchor your hands on the patient• If using transverse, keep angling probe back &

forth to keep needle tip in view