<p begin="00:00:07.403" end="00:00:09.316" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.316" end="00:00:10.984" style="s2">with a vascular exam type,</p>
<p begin="00:00:10.984" end="00:00:13.876" style="s2">is used to perform an<br />ultrasound guided insertion</p>
<p begin="00:00:13.876" end="00:00:17.790" style="s2">of a femoral artery catheter<br />via a transverse approach.</p>
<p begin="00:00:17.790" end="00:00:19.896" style="s2">The patient is in a supine position,</p>
<p begin="00:00:19.896" end="00:00:22.611" style="s2">with the operator at the right side.</p>
<p begin="00:00:22.611" end="00:00:24.986" style="s2">The transducer is placed transversely,</p>
<p begin="00:00:24.986" end="00:00:27.338" style="s2">just inferior to the inguinal crease,</p>
<p begin="00:00:27.338" end="00:00:29.254" style="s2">with the orientation marker direction</p>
<p begin="00:00:29.254" end="00:00:32.996" style="s2">to the patient's right<br />at a 9 o'clock position.</p>
<p begin="00:00:32.996" end="00:00:35.117" style="s2">The superficial femoral artery</p>
<p begin="00:00:35.117" end="00:00:38.847" style="s2">is seen as a dark, anechoic,<br />pulsatile, circular structure</p>
<p begin="00:00:38.847" end="00:00:41.307" style="s2">in the mid-portion of<br />the ultrasound image.</p>
<p begin="00:00:41.307" end="00:00:43.629" style="s2">Deeper, and slightly to<br />the right of the image,</p>
<p begin="00:00:43.629" end="00:00:45.526" style="s2">the femoral vein will appear</p>
<p begin="00:00:45.526" end="00:00:48.165" style="s2">as a dark, anechoic, elliptical shape</p>
<p begin="00:00:48.165" end="00:00:50.972" style="s2">that is compressible<br />with transducer pressure.</p>
<p begin="00:00:50.972" end="00:00:53.170" style="s2">Adjust the transducer so it is centered</p>
<p begin="00:00:53.170" end="00:00:56.471" style="s2">over the femoral artery,<br />lateral to the vein.</p>
<p begin="00:00:56.471" end="00:00:59.547" style="s2">Follow the needle entry by<br />slowing sliding the transducer</p>
<p begin="00:00:59.547" end="00:01:01.993" style="s2">in the direction of needle advancement.</p>
<p begin="00:01:01.993" end="00:01:05.135" style="s2">The needle will appear<br />as a small, bright dot.</p>
<p begin="00:01:05.135" end="00:01:06.672" style="s2">When the needle tip appears,</p>
<p begin="00:01:06.672" end="00:01:10.067" style="s2">the transducer should be advanced<br />a short distance distally,</p>
<p begin="00:01:10.067" end="00:01:12.259" style="s2">to follow the tip of the needle trajectory</p>
<p begin="00:01:12.259" end="00:01:15.350" style="s2">and stay in advance of the needle entry.</p>
<p begin="00:01:15.350" end="00:01:16.591" style="s2">The needle is slowly advanced</p>
<p begin="00:01:16.591" end="00:01:19.257" style="s2">under direct ultrasound visualization,</p>
<p begin="00:01:19.257" end="00:01:23.008" style="s2">until the tip is seen to<br />puncture the femoral artery.</p>
<p begin="00:01:23.008" end="00:01:24.972" style="s2">The transducer should be moved slightly</p>
<p begin="00:01:24.972" end="00:01:28.121" style="s2">proximally and distally to<br />confirm that the needle tip</p>
<p begin="00:01:28.121" end="00:01:31.288" style="s2">lies in the mid-portion of the artery.</p>