Let’s talk the same language: US probe movements

The six types of movements of the ultrasound probe
The six types of movements of the ultrasound probe

The good vein

  • Size >4mm (increases first attempt success)
  • Depth <1 cm (the IV will last longer)
  • Proximal veins for rapid transfusion, pressors, IV contrast
  • Forearm veins when able, save the proximal access for subsequent attempts
  • Anechoic and easily compressible, no overlying erythema or tenderness (find another spot on suspicion for DVT or thrombophlebitis)
  • Try to avoid putting your needle through muscle or deep tissue (painful, risk for hematoma)

The quest for the vein

  • Put a proximal tourniquet, close to the axilla 
  • Use the linear probe 
  • Set the depth (depending on body size, but the minimum depth needed); and gain (blood vessels look anechoic)
  • Be liberal with the gel, and slide your probe up and down the arm until you find a “good vein” (see above)
  • Wipe down all the gel from the patient and probe (you’ll thank me later) 
  • “Aseptic” technique:  probe cover (only to cover the area of contact between the probe and the skin), examination gloves, and individual gel package (ACEP statement here).
Recommendations Regarding Probe Covers and Gel Types for Procedures and Non-Intact Skin
Recommendations Regarding Probe Covers and Gel Types for Procedures and Non-Intact Skin

Out-of-plane: “the creep technique”

Ultrasound axial view (out of plane technique)
Ultrasound axial view (out of plane technique)
  • Vein in axial view: rounded circle, thin walls, anechoic, easily compressible 
  • Use as little gel as possible 
  • Clean the skin with antiseptic of choice 
  • Place the vein in the center of the screen, you can use M mode to mark the middle 
  • See the depth (distance from skin to target) and calculate your entry angle 
  • Insert your needle in the middle of the probe, once you see the needle tip on the screen halt the needle movement. 
  • Slightly slide the probe proximally, until you don’t see the needle tip anymore
  • Advance your needle once again until visualized on the screen. Maintain the vein and the needle on the center. 
  • Never move both hands at the same time; either the probe or the needle are advancing. 
  • Repeat this sequence until your needle is free (not touching the vein walls) in the middle of the vessel. 
  • Thread the catheter and secure the line

In-plane

Ultrasound longitudinal view (in plane technique)
Ultrasound longitudinal view (in plane technique)
  • Get a longitudinal view of the vein, tilt side to side to find the greater diameter, and rotate the probe until you find a straight looking pipe 
  • Little gel. Antiseptic. Go 
  • Calculate your entry angle depending on the depth of the vein 
  • Insert you needle from the distal end of the probe, the needle should be parallel and underneath the US beam at all times 
  • You should be able to see the whole needle shaft and the tip 
  • Advance until at least half of the needle is inside the vessel before threading the catheter

Wonder how I made the ultrasound model you see in these videos? Check out this step by step guide on how to make your own homemade ultrasound model with gelatin!

Sabrina Rodera Zorita

March 2024
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