<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>

<p begin="00:00:07.000" end="00:00:09.879" style="s2">- [Voiceover] A curved or<br />phased array transducer with an</p>
<p begin="00:00:09.879" end="00:00:12.611" style="s2">abdomen exam type is used to perform a</p>
<p begin="00:00:12.611" end="00:00:14.407" style="s2">renal ultrasound exam.</p>
<p begin="00:00:14.407" end="00:00:17.740" style="s2">The kidney should be<br />evaluated in two planes.</p>
<p begin="00:00:17.740" end="00:00:21.151" style="s2">The transducer is placed in<br />a long access orientation</p>
<p begin="00:00:21.151" end="00:00:23.459" style="s2">along the right midaxillary line,</p>
<p begin="00:00:23.459" end="00:00:24.913" style="s2">at the costal margin,</p>
<p begin="00:00:24.913" end="00:00:27.233" style="s2">with the orientation<br />marker directed toward the</p>
<p begin="00:00:27.233" end="00:00:28.487" style="s2">patient's head.</p>
<p begin="00:00:28.487" end="00:00:30.913" style="s2">If it is difficult to<br />visualize the kidney,</p>
<p begin="00:00:30.913" end="00:00:33.981" style="s2">a deep inspiration will move<br />the kidney below the ribs,</p>
<p begin="00:00:33.981" end="00:00:36.044" style="s2">for easier access.</p>
<p begin="00:00:36.044" end="00:00:39.524" style="s2">It may also be necessary to<br />move the transducer proximally</p>
<p begin="00:00:39.524" end="00:00:42.725" style="s2">along the midaxillary line,<br />to visualize the kidneys,</p>
<p begin="00:00:42.725" end="00:00:44.939" style="s2">using an intercostal approach.</p>
<p begin="00:00:44.939" end="00:00:48.233" style="s2">Using this approach will<br />result in rib shadow artifacts</p>
<p begin="00:00:48.233" end="00:00:50.609" style="s2">overlying the ultrasound image.</p>
<p begin="00:00:50.609" end="00:00:53.963" style="s2">Once the kidney is identified,<br />the transducer is slightly</p>
<p begin="00:00:53.963" end="00:00:58.130" style="s2">rotated to adjust for the oblique<br />orientation of the kidney.</p>
<p begin="00:01:04.713" end="00:01:08.435" style="s2">The transducer is swept<br />from anterior to posterior</p>
<p begin="00:01:08.435" end="00:01:10.457" style="s2">to image the kidney parenchyma,</p>
<p begin="00:01:10.457" end="00:01:14.119" style="s2">which will appear hypoechoic<br />when compared to the liver.</p>
<p begin="00:01:14.119" end="00:01:16.892" style="s2">The renal pyramids are<br />triangular in shape,</p>
<p begin="00:01:16.892" end="00:01:19.550" style="s2">and darker than the renal cortex.</p>
<p begin="00:01:19.550" end="00:01:23.140" style="s2">The renal pelvis will appear<br />as bright, hyperechoic echoes</p>
<p begin="00:01:23.140" end="00:01:24.546" style="s2">within the kidney.</p>
<p begin="00:01:24.546" end="00:01:27.247" style="s2">To obtain a transverse access view,</p>
<p begin="00:01:27.247" end="00:01:29.659" style="s2">rotate the transducer 90 degrees,</p>
<p begin="00:01:29.659" end="00:01:31.652" style="s2">from the long access position.</p>
<p begin="00:01:31.652" end="00:01:34.098" style="s2">The kidney appear as a circular structure,</p>
<p begin="00:01:34.098" end="00:01:35.311" style="s2">with a horseshoe shape,</p>
<p begin="00:01:35.311" end="00:01:37.249" style="s2">at the level of the renal pelvis.</p>
<p begin="00:01:37.249" end="00:01:40.994" style="s2">The transducer is swept from<br />the superior to inferior poles,</p>
<p begin="00:01:40.994" end="00:01:43.494" style="s2">to evaluate the entire kidney.</p>

<p begin="00:00:07.406" end="00:00:09.090" style="s2">- [Voiceover] A phased array transducer</p>
<p begin="00:00:09.090" end="00:00:11.818" style="s2">with a cardiac exam<br />type is used to perform</p>
<p begin="00:00:11.818" end="00:00:15.443" style="s2">an Inferior Vena Cava ultrasound exam.</p>
<p begin="00:00:15.443" end="00:00:18.065" style="s2">The Inferior Vena Cava is evaluated</p>
<p begin="00:00:18.065" end="00:00:20.928" style="s2">at the level of the liver and diaphragm.</p>
<p begin="00:00:20.928" end="00:00:23.006" style="s2">The transducer is placed to the right</p>
<p begin="00:00:23.006" end="00:00:24.914" style="s2">of the epigastric midline,</p>
<p begin="00:00:24.914" end="00:00:28.139" style="s2">with the orientation marker<br />to the patient's feet.</p>
<p begin="00:00:28.139" end="00:00:29.684" style="s2">As an alternative approach,</p>
<p begin="00:00:29.684" end="00:00:33.224" style="s2">this exam may be performed<br />using an abdomen exam type</p>
<p begin="00:00:33.224" end="00:00:36.593" style="s2">with the orientation marker<br />to the patient's head.</p>
<p begin="00:00:36.593" end="00:00:39.491" style="s2">The liver, diaphragm, right atrium,</p>
<p begin="00:00:39.491" end="00:00:43.640" style="s2">and Inferior Vena Cava are<br />identified in this view.</p>
<p begin="00:00:43.640" end="00:00:46.020" style="s2">Sweep from side-to-side to differentiate</p>
<p begin="00:00:46.020" end="00:00:49.252" style="s2">the Inferior Vena Cava from the aorta.</p>
<p begin="00:00:49.252" end="00:00:52.603" style="s2">The aorta is thicker walled and pulsatile.</p>
<p begin="00:00:52.603" end="00:00:56.534" style="s2">The superior mesenteric and<br />celiac branches of the aorta</p>
<p begin="00:00:56.534" end="00:00:58.923" style="s2">are identified at this level.</p>
<p begin="00:00:58.923" end="00:01:01.883" style="s2">The Inferior Vena Cava is thin walled</p>
<p begin="00:01:01.883" end="00:01:04.668" style="s2">and changes caliber with respiration.</p>
<p begin="00:01:04.668" end="00:01:06.928" style="s2">The diameter of the Inferior Vena Cava</p>
<p begin="00:01:06.928" end="00:01:11.095" style="s2">decreases with inspiration<br />and increases with expiration.</p>