Point of Care Ultrasound UCSF Continuing Medical Education Skin and - PowerPoint PPT Presentation

Point of Care Ultrasound UCSF Continuing Medical Education Skin and Soft Tissue and Central Venous Cannulation Brandon Boesch, DO October 21-22, 2018

Disclosure I have no relevant financial relationships with any companies related to the content of this course.

Skin and Soft Tissue Ultrasound

SSTI Ultrasound US can differentiate between cellulitis and abscess Reverberation artifact can show air in soft tissue representing necrotizing fasciitis 4

Transducer High frequency linear transducer for depth up to 4 cm 5

Normal skin and soft tissues by ultrasound. B, bone; F, fascia; M, muscle; V, superficial vein; S, subcutaneous tissue. Soni N., Arntfield R., & Kory P. (2015) Point-of-Care ultrasound. Philadelphia: Elsevier 6

Cobblestoning 7

Abscess Soni N., Arntfield R., & Kory P. (2015) Point-of-Care ultrasound. Philadelphia: Elsevier 8

Abscess with ?Nec Fasc 9

Rib Fracture Soni N., Arntfield R., & Kory P. (2015) Point-of-Care ultrasound. Philadelphia: Elsevier 10

Goals for scanning - Look at the soft tissue planes in the leg - Identify vessels, bone, muscle, possibly lymph nodes - Can look at the abdominal wall to see rectus and epigastric vessels 11

Central Venous Cannulation 12

Pre Procedure Technique Position the machine for easy viewing Check Lung Sliding Look at entire vessel on both sides of the neck Look for compressibility, clot, stenosis 13

Identify the Vein Not always this obvious Compression technique Color Doppler Soni N., Arntfield R., & Kory P. (2015) Point-of- Care ultrasound. Philadelphia: Elsevier 14

Soni N., Arntfield R., & Kory P. (2015) Point-of-Care ultrasound. Philadelphia: Elsevier 15

Use Color Doppler Red means flow towards the probe, not arterial flow To identify the artery, look for pulsatile appearance and disappearance of color Mosaic, continuous flow indicates a vein 16

Technique Prepare all materials in order needed for procedure on sterile tray or drape Select best target site Place needle with real time US guidance Visualize wire in vein with US prior to dilation Check lung sliding after procedure 17

� Out of plane Longitudinal Approach Transverse Approach visualization 18

19 Soni N., Arntfield R., & Kory P. (2015) Point-of-Care ultrasound. Philadelphia: Elsevier

Visualize the Wire 20

Scanning Today - Visualize the right and left IJ, carotid, and surrounding structures - Figure out the best location to place a line on your model and demonstrate with your finger - At the table IV models, try to follow your needle tip into the vessel in both transverse and longitudinal 21