It is obvious for the clinical value of ultrasound visualization, but the lack of suitable products has led to disadvantages in popularization. Now iTrason portable handheld ultrasound gives us a good solution.
In the context of aging society, more and more surgical patients need to undergo radial artery puncture and catheterization to improve the quality of perioperative management.
Regarding the problem of radial artery puncture, the operation is actually very simple, but it is more delicate. Now that there is ultrasound, it’s even less of a problem.
Today, we will introduce some experience with ultrasound perforating arteries. Of course, I don’t deny the significance of blind puncture, and I believe that everyone’s skills are very good, and it is possible to puncture it even with eyes closed.
complications of radial artery puncture
The USB linear ultrasound probe UL10-5S is very small(10*3*2cm) and lighter than iPhone XR. It uses the type-c port. After connecting with the mobile phone, it will automatically open the app and identify the probe, which takes about 5 seconds.
The most important thing is whether the ultrasound image is good or not, and the color of image cleaning is an important indicator of ultrasound quality. UL10-5S is a high-frequency linear array transducer with a maximum frequency of 12MHz, and was originally designed for the dialysis department(optimized for vascular imaging) to assess arteriovenous fistulas.
At present, the most commonly used method is the puncture method in the long axis plane. This method can more directly determine the position of the needle tip.
keep the probe perpendicular to the skin ASAP
However, there is a mistake that a novice can easily make.
Sometimes, it is obvious that the needle tip is in the center of the blood vessel on the ultrasound image, but neither the blood return nor the cannula can be sent. Why?
In this case, most of it is because the needle tip is not in the blood vessel, but the blood vessel is relatively thin. And the puncture needle is just next to the blood vessel. Due to the thickness of the ultrasound beam, it is mistaken that the two are in the same plane.
Therefore, when we perform the puncture, there are two reliable signals. One is the image of the needle pressing the anterior wall of the blood vessel, and the other is the blood return.
signs of anterior vascular depression
Another situation is that the blood vessels are relatively shallow, and the blood has returned before the needle is seen under ultrasound. Don’t worry. Gently slide the probe left and right to see the needle tip (the bright spot in the blood vessel), then lower the angle of the needle and continue to insert the needle. At this time, you can usually see the puncture needle.
Now, let me introduce the currently popular puncture method “short axis-sliding probe”.
Because the short axis puncture is easier to determine the center of the blood vessel, this method is good for thin blood vessels (When the blood vessel is relatively thin, the long axis direction is not easy to penetrate the blood vessel).
This method usually looks at the distance from the blood vessel to the skin first, and then determines the puncture point. Keep the probe perpendicular to the angle of the needle, not perpendicular to the skin.
By sliding the probe back and forth, confirm the position of the needle tip, imagine the bright spots as a straight line, and adjust the direction of the needle.
When the needle tip enters the blood vessel, adjust the dye head to be perpendicular to the skin, continue to slide the probe back and forth, confirm the position of the needle tip, lower the needle angle, continue to advance 2mm, and then push the cannula.
This method is good, but it needs to slide the probe back and forth many times. It asks for the ability of the eye-hand coordination.
The above are some of our methods and experience. Now, for those patients who are expected to have difficulty in vascular puncture, we will directly choose ultrasound-guided puncture to avoid unnecessary complications caused by repeated puncture.
Tips: the unwatermarked photos in the article are from the article ultrasound-guided cannulation of hemodialysis access by Tadashi Kamata