<p begin="00:00:07.862" end="00:00:09.374" style="s2">- [Voiceover] A curved array transducer</p>
<p begin="00:00:09.374" end="00:00:10.901" style="s2">with an abdomen exam type</p>
<p begin="00:00:10.901" end="00:00:14.038" style="s2">is used to perform an<br />ultrasound guided paracentesis.</p>
<p begin="00:00:14.038" end="00:00:16.119" style="s2">It is easier to perform this exam</p>
<p begin="00:00:16.119" end="00:00:18.248" style="s2">when the bladder is not filled.</p>
<p begin="00:00:18.248" end="00:00:20.735" style="s2">The patient is placed<br />in a supine position.</p>
<p begin="00:00:20.735" end="00:00:24.165" style="s2">The abdominal cavity is<br />evaluated in two planes.</p>
<p begin="00:00:24.165" end="00:00:27.188" style="s2">Place the transducer in<br />a transverse position</p>
<p begin="00:00:27.188" end="00:00:30.032" style="s2">with the orientation marker to the right.</p>
<p begin="00:00:30.032" end="00:00:32.876" style="s2">The transducer is placed<br />at the lateral border</p>
<p begin="00:00:32.876" end="00:00:35.719" style="s2">of the rectus sheath at<br />the level of the umbilicus.</p>
<p begin="00:00:35.719" end="00:00:38.433" style="s2">To evaluate the abdominal<br />cavity for free fluid,</p>
<p begin="00:00:38.433" end="00:00:42.920" style="s2">sweep the transducer from an<br />inferior to superior position.</p>
<p begin="00:00:42.920" end="00:00:45.829" style="s2">Fluid will appear hypoechoic or anechoic</p>
<p begin="00:00:45.829" end="00:00:47.828" style="s2">and accumulate in the lateral gutter</p>
<p begin="00:00:47.828" end="00:00:49.827" style="s2">and between loops of bowel.</p>
<p begin="00:00:49.827" end="00:00:51.762" style="s2">To obtain a long axis view,</p>
<p begin="00:00:51.762" end="00:00:55.516" style="s2">rotate the transducer 90 degrees<br />with the orientation marker</p>
<p begin="00:00:55.516" end="00:00:58.036" style="s2">directed to the point of needle entry.</p>
<p begin="00:00:58.036" end="00:01:00.831" style="s2">Sweep the transducer<br />across the abdominal cavity</p>
<p begin="00:01:00.831" end="00:01:04.651" style="s2">from left to right to evaluate<br />the abdomen for free fluid.</p>
<p begin="00:01:04.651" end="00:01:07.170" style="s2">A needle insertion site should be chosen</p>
<p begin="00:01:07.170" end="00:01:08.991" style="s2">in the lateral abdominal area</p>
<p begin="00:01:08.991" end="00:01:11.364" style="s2">in a dependent area of<br />the fluid collection</p>
<p begin="00:01:11.364" end="00:01:13.867" style="s2">which is clear from loops of bowel.</p>
<p begin="00:01:13.867" end="00:01:16.825" style="s2">The needle should be inserted<br />lateral to the rectus sheath</p>
<p begin="00:01:16.825" end="00:01:20.499" style="s2">in a transverse fashion to<br />avoid the epigastric artery.</p>
<p begin="00:01:20.499" end="00:01:23.571" style="s2">Follow the needle entry by<br />slowly sliding the transducer</p>
<p begin="00:01:23.571" end="00:01:26.204" style="s2">in the direction of needle advancement.</p>
<p begin="00:01:26.204" end="00:01:30.040" style="s2">The needle will appear as a<br />small, bright hypoechoic dot.</p>
<p begin="00:01:30.040" end="00:01:31.828" style="s2">When the needle tip appears,</p>
<p begin="00:01:31.828" end="00:01:35.241" style="s2">the transducer should be advanced<br />a short distance distally</p>
<p begin="00:01:35.241" end="00:01:38.150" style="s2">to follow the tip of<br />the needle trajectory.</p>
<p begin="00:01:38.150" end="00:01:39.792" style="s2">The needle is slowly advanced</p>
<p begin="00:01:39.792" end="00:01:42.035" style="s2">under direct ultrasound visualization</p>
<p begin="00:01:42.035" end="00:01:44.034" style="s2">until the tip is seen to indent</p>
<p begin="00:01:44.034" end="00:01:46.830" style="s2">and then puncture the parietal peritoneum.</p>
<p begin="00:01:46.830" end="00:01:49.758" style="s2">The transducer should be<br />moved slightly proximally</p>
<p begin="00:01:49.758" end="00:01:53.925" style="s2">and distally to confirm<br />location of the needle tip.</p>