Procedure: Femoral artery and vein catheter insertions

These two videos demonstrate the ultrasound techniques for femoral artery and vein catheter insertions.

First, the femoral artery catheter insertion:

Second, the femoral vein catheter insertion:

These are both very similar, since you will be locating both the femoral artery and vein when you perform either procedure. 

Localization of both of these structures is key when performing these procedures. It is important to remember the anatomy of the femoral region. The femoral artery runs laterally to the femoral vein and medially to the femoral nerve as in the figure below.

However, anatomical variants do exist, so this is not always the case. To further help with localization of your chosen vessel, remember that that veins are compressible on ultrasound, while arteries are not. 

Procedure: Radial Artery Catheter Insertion

Although radial artery catheter insertion can be done as a palpation-guided procedure, it can sometimes be difficult to perform successfully. This video provides a general overview on how to perform this procedure with ultrasound guidance.

When performing this procedure, the radial artery appears as an anechoic circle that is pulsatile. Unlike the surrounding veins, the radial artery should not be compressible. If you are having difficulty finding the radial artery, the use of colour doppler can help with localization.

Procedure: Pericardiocentesis

This video provides an overview of how to use an ultrasound to perform a pericardiocentesis using the cardiac probe.

As with most ultrasound guided procedures, it's important to visualize the needle on insertion and correctly identify the surrounding anatomy. The video provides a good overview of cardiac anatomy as well as the location of a pericardial effusion on echo.

Procedure: Paracentesis

This video below describes how to use bedside ultrasonography while performing a paracentesis.

With ultrasound, an area with an adequate amount of free fluid can be identified, and the risk of perforating bowel can be decreased. With the use of the abdominal probe, this area can be identified quickly by scanning the abdomen to obtain both transverse and long axis views.

Procedure: Thoracentesis

Ultrasound is very useful when performing thoracentesis for both confirming the presence of a pleural effusion and for locating the appropriate area for needle insertion. 

This video provides an explanation on ultrasound positioning and landmarking for ultrasound guided thoracentesis. 

Procedure: Internal Jugular Central Line Insertion

One of the procedures where ultrasound is useful is for central line insertion into the jugular vein. In fact, ultrasound guidance for internal jugular line placement is considered standard of care.

The ultrasound portion of the technique begins at 3:43. You can use the transverse (at 5:00) or longitudinal view (at 5:05) to visualize the tip of the needle as it is inserted into the jugular vein.

When inserting the needle, you should assure the following:
- The internal jugular is centered on the ultrasound image
- The ultrasound probe is perpendicular to the needle's insertion angle is using the transverse view
- The needle's insertion point is at the middle of the ultrasound probe

As mentioned in the video, you should also confirm that the wire is correctly positioned in the jugular vein before proceeding with dilating.