Diagnostic ultrasound ( PDFDrive )

CHAPTER 56 Pediatric Interventional Sonography 1955
B
A
C
D
FIG. 56.11 Technique for Locating Exact Position of a Deep Vein Prior to Peripherally Inserted Central Catheter (PICC) Line Placement.
(A) With the transducer held transverse to the direction of the target vein, a partly unfolded paper clip, placed between the skin and the transducer
face, is moved backward and forward ([B] and [C]) to locate the vein for accurate application of subcutaneous local anesthetic. The transducer is
held transverse to the needle path to avoid beam-width errors. The thin paperclip artifact (arrows) localizes the vein (V). Note that with a tourniquet
in place, especially in a small baby ([B]-[D]), color Doppler sonography may show no low. A tight tourniquet in a baby can obstruct even arterial
low, resulting in erroneous placement of an intraarterial PICC line, a very dangerous event, if unrecognized.