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Fig. 4 | Renal Replacement Therapy

Fig. 4

From: Ultrasound-guided cannulation of hemodialysis access

Fig. 4

Longitudinal image of a needle within the internal jugular vein. After advancing a needle for the catheter-over-needle technique into a rather collapsed jugular vein under transverse imaging, the probe is rotated 90° to obtain a longitudinal image. This not only ascertains the intravenous placement of the needle tip (A) but also ensures the intravenous placement of the catheter tip (B). By measuring the distance between the tips of the needle and catheter in advance, the precise location of the catheter tip can be determined on the ultrasound screen. C is the entry site of the vein. Just before the removal of the needle and insertion of the guidewire, the distance from B to C should be at least 5 mm to facilitate guidewire insertion. However, one must not advance the needle too deeply because the deeper the needle advances, the more obscure the image becomes in most cases of central veins

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