Section

Ultrasound basics relevant to vascular access

1. Linear array probe: High-frequency probes are ideal for imaging superficial structures such as veins and arteries in extremities. Use presets for vascular access on silicon-chip–based whole-body ultrasound systems (Butterfly IQ, Butterfly Network, Inc, Guilford, CT).
2. Depth setting: Adjust depth setting to place the vessel of interest in the middle of the screen.
3. Gain: Use higher gain to distinguish between dark lumen and lighter walls of the vein and surrounding structures (blood is hypoechoic).
4. Imaging the bevel: Flat solid structures held perpendicular to ultrasound beam will reflect acoustic beams directly back at the probe and show brightest (hyperechoic) compared to surrounding structures. Bevel of the needle is the only relatively flat structure in cross section; therefore, it is the ideal target to guide vascular access.
5. Further discussion showcases real-time ultrasound-guided peripheral IV placement with a focus on the bevel. Similar concepts apply to ultrasound guidance for arterial and central lines.