Consequently these veins are not generally used for

  • No School
  • AA 1
  • 360

This preview shows page 303 - 307 out of 360 pages.

not readily palpable. Consequently, these veins are not generally used for Figure 15.20 Transverse view of external jugular (EJ) and internal jugular (IJ) veins. Procedural ultrasound 289 Vascular access
Image of page 303

Subscribe to view the full document.

intravenous catheter placement in the absence of ultrasound guidance. In most patients, the depth of these vessels requires that a longer intravenous catheter (1.75–2.0 in [4.4–5.0 cm]) be used. Caution should be exercised with the more proximal brachial vein because it lies immediately adjacent to the ulnar and median nerves. More distal peripheral veins (such as in the ante- cubital fossa or forearm) may be cannulated as well using the techniques described here. Focused question 1. Where is the target vein? Anatomy The axillary vein divides into the cephalic vein, which runs superficially toward the lateral (dorsal) aspect of the upper arm; the basilic vein, which courses superficially along the inferior and medial (ventral) aspect of the arm; and the brachial vein, which runs deeply inferior to the biceps muscle ( Figure 15.21 ). Figure 15.21 Upper arm vasculature. The basilic vein (A), brachial artery (B), cephalic vein (C), and median antecubital vein (D) are visualized. The superficial and deep brachial veins are not visible here, but flank the brachial artery. Image reproduced from Maclise’s Surgical Anatomy , Plate 15. Philadelphia, PA: Blanchard and Lea, 1859 (image out of copyright). 290 Procedural ultrasound Vascular access
Image of page 304
The basilic and cephalic veins rejoin in the antecubital fossa, and the brachial vein runs deep in this location. Frequently, the brachial vein will be found as paired superficial and deep brachial veins. Technique Probe selection Generally, a high-frequency linear transducer is used. Special equipment For deep vein cannulation, a longer catheter is required (at least 2 in [5 cm]). Sterile probe covers can be used for sterile peripheral access. Setup As usual, the ultrasound machine should be placed in a position where the target anatomy on the patient and the ultrasound screen are both readily visible ( Figure 15.22 ). Thus, the operator will generally be facing both. The patient should be placed in the standard position for the procedure. A single-operator approach can be used, as described previously. Alterna- tively, one operator can demonstrate the vessel using ultrasound while another cannulates the vein. This approach can be incredibly useful when ultrasound is used to demonstrate vessel location and depth so that an experi- enced nurse can place the intravenous line. Figure 15.22 Positioning for ultrasound-guided peripheral vein cannulation. Procedural ultrasound 291 Vascular access
Image of page 305

Subscribe to view the full document.

Procedure As described for central venous cannulation, survey the vessels of interest using the transducer in the transverse plane. Either the static or the dynamic technique can be employed. In Figure 15.23 , the brachial artery is seen adjacent to the superficial brachial and deep brachial veins. The basilic vein is visualized as well.
Image of page 306
Image of page 307
  • Fall '19

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern

Ask Expert Tutors You can ask You can ask ( soon) You can ask (will expire )
Answers in as fast as 15 minutes