The operator will therefore be facing both the

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The operator will therefore be facing both the patient and the ultrasound machine. If a static approach is employed, the vessel should be visualized at this point, and patency should be checked (using compressibility as described in Chapter 8 ). Center the target vessel on the screen – this places the transducer over the center of the vessel. A mark should be placed on the skin at the midpoint of the transducer to mark vessel location. To assess vessel trajec- tory, repeat this process once more at a point on the vessel 1–2 cm away. Thus, the two points marked on the skin will define a line and act as a better guide for needle direction than a single point. For dynamic approaches , the patient should be draped and prepped in the usual sterile fashion. Next, the transducer should be prepped in a sterile fashion. Transducer preparation The sterile probe cover kit (or a sterile glove if kits are unavailable) should be placed on the sterile field. A non-sterile assistant should hold the probe upright and apply standard (non-sterile) conducting gel to the transducer. The probe is then inserted into the sterile sheath and placed on the sterile field. Sterile gel (from silver lubricant packages) can then be placed on the sterile glove on top of the probe ( Figure 15.8 ). Probe orientation Note the location of the probe marker. The probe marker and the screen marker (see Chapter 1 ) should be pointing in the same direction. That is, the Figure 15.7 Patient positioning for central venous access. Note that the probe marker should face the operator’s left, so that the left of the screen and the left of the probe are aligned. Procedural ultrasound 279 Vascular access
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probe marker should correspond to the left side of the operator (not neces- sarily the left side of the patient) and the left side of the ultrasound image on the screen. This way, if the needle moves to the left of the probe, it will also move to the left on the screen. For an in-plane (long-axis) approach, most operators hold the probe marker toward themselves so that the needle will be visualized coming in from the left side of the screen. Holding the probe Proper hand position was described in Chapter 1 . A comfortable and stable hand position is even more important when the probe is used to guide the placement of a needle. As shown in Figure 15.9 , the first three fingers should hold the probe, leaving the remaining fingers and heel of the hand free for stabilization. Hand position is a compromise between stability, com- fort, and safety: be sure to keep your fingers away from the needle! Vessel identification Place the transducer at the site of anticipated needle placement. Search for the vessel using local ultrasound landmarks as a guide (sternocleidomastoid Figure 15.8 Probe preparation.
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