Three-step method for ultrasound-guided central vein catheterization

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Presentation transcript:

Three-step method for ultrasound-guided central vein catheterization J. Tokumine, A.T. Lefor, A. Yonei, A. Kagaya, K. Iwasaki, Y. Fukuda British Journal of Anaesthesia Volume 110, Issue 3, Pages 368-373 (March 2013) DOI: 10.1093/bja/aes381 Copyright © 2013 The Author(s) Terms and Conditions

Fig 1 Pitfalls of the LAX-IP technique. Pitfalls associated with the LAX-IP are demonstrated using a simulator. V, vein; A, artery. (a) The longitudinal view shows what appears to be a correct orientation. (b) Actually, the tip of the needle is in the artery. (c) The three-dimensional graphic illustrates that the needle went through the vein into the artery. British Journal of Anaesthesia 2013 110, 368-373DOI: (10.1093/bja/aes381) Copyright © 2013 The Author(s) Terms and Conditions

Fig 2 Side-scape scan technique. The details of the side-scape scan technique are shown in sequence, in (a–h). (a) Find the targeted vein using a short-axis view, then turn the ultrasound probe by 90°. (b) Although the ultrasound beam directed is laterally, the long-axis view looks like the long axis through the centre of the vein and parallel to the vein walls. (c) Turn the distal part of the probe to the right using the centre of the proximal edge (black dot) as the turning point till the right lateral wall can be identified (bullet shape of the walls). (d) Turn the probe to the left using the same motion described in (c). (e) Repeat the motions as in (c) and (d) to find the presumed centre of the vein (black dot). (f) Turn the proximal part of the probe to the right till the right lateral wall is identified. (g) Turn the proximal part of the probe to the left using the same motion described in (f). (h) Repeat the motions as in (f) and (g) to find the presumed centre of the vein. At this stage, both edges of the probe can be set close to the centre of the vein. British Journal of Anaesthesia 2013 110, 368-373DOI: (10.1093/bja/aes381) Copyright © 2013 The Author(s) Terms and Conditions

Fig 3 Side-swing scan technique. Swing the probe laterally to identify the location of surrounding structures. The dashed lines show potentially hazardous directions, but the solid arrow shows the safest direction. (A indicates the axillary artery, V indicates the axillary vein, and L indicates the lung.) British Journal of Anaesthesia 2013 110, 368-373DOI: (10.1093/bja/aes381) Copyright © 2013 The Author(s) Terms and Conditions

Fig 4 Real-time ultrasound-guided central venous catheterization. A needle has been introduced into the infraclavicular axillary vein utilizing ultrasound guidance with a needle guide controlling the passage of the needle in an in-plane approach. Inset: the needle tip is seen within the vein (arrow). British Journal of Anaesthesia 2013 110, 368-373DOI: (10.1093/bja/aes381) Copyright © 2013 The Author(s) Terms and Conditions