0:00 - [Narrator] This video is for demonstration

0:02 and educational purposes only.

0:04 Please follow your own institutional guidelines

0:06 on sterility and safety.

0:09 A linear ray transducer with a venous exam type

0:11 is used to perform an ultrasound-guided insertion

0:14 of a subclavian vein catheter via a transverse approach.

0:19 The patient is in a supine position with the head neutral.

0:22 The operator should be positioned

0:23 on the same side that the catheter will be inserted.

0:27 The transducer is placed transversely on the vessel,

0:30 just inferior to the midportion of the clavicle,

0:33 with the orientation marker directed to the patient's head

0:36 at a 12 o'clock position.

0:38 The subclavian vein is seen as an anechoic circle,

0:41 just inferior and deep to the clavicle.

0:44 The transducer should be slowly moved

0:46 one to two inches laterally,

0:48 with the face of the transducer staying below the clavicle

0:51 to obtain the best view of the distal subclavian

0:54 and proximal axillary vein.

0:56 It is important to note that the lung lies

0:58 directly posterior to the vessel,

1:01 so posterior wall puncture of the vein should be avoided.

1:04 Adjust the transducer so the vein is centered

1:07 within the ultrasound image.

1:09 With the needle positioned just superior to the transducer,

1:12 slowly insert the needle

1:14 next to the center line on the transducer.

1:17 The needle will appear as a small bright dot

1:19 in the ultrasound image.

1:21 When the needle tip appears,

1:22 slide the transducer a short distance medially

1:25 until the needle is no longer visible.

1:28 Once again, advance the needle slowly

1:30 until it is visible in the ultrasound image.

1:33 Repeat the process to ensure that the needle tip

1:36 is advanced under direct ultrasound guidance.

1:39 Continue advancing the needle until the tip

1:42 is seen to indent and then puncture the vein.

1:44 Confirm that the needle tip lies

1:46 in the midportion of the vein by rotating the probe

1:49 90 degrees to get an in-plane longitudinal view

1:52 of the needle within the subclavian proximal axillary vein.