Ultrasound Guidance Flashcards

A nurse notices that the ultrasound image shows a 'dirty shadow' artifact below a hyperechoic structure during vessel scanning. This artifact most likely indicates:

Answer: A calcified vessel wall or foreign body

A clean acoustic shadow behind a hyperechoic structure suggests calcification or a dense foreign body, while a 'dirty shadow' is more associated with gas/air.

The catheter-to-vein ratio for PICC placement, assessed via ultrasound, should ideally not exceed:

Answer: 33%

A catheter-to-vein ratio of ≤33% is recommended to minimize thrombosis risk by allowing adequate blood flow around the catheter.

Which technique uses ultrasound to inject saline around a nerve or vessel to create a tissue plane before catheter insertion?

Answer: Hydrodissection

Hydrodissection uses saline injected under ultrasound guidance to separate tissue planes, potentially displacing nerves or other structures before needle advancement.

When using M-mode ultrasound to assess vessel pulsatility during vascular access assessment, what does a flat, non-pulsatile waveform most likely represent?

Answer: A patent peripheral vein

Veins display flat, non-pulsatile waveforms on M-mode, while arteries show cyclical pulsatile waveforms corresponding to cardiac contractions.

A patient has a history of multiple previous PIVs and difficult access. Ultrasound reveals the cephalic vein is patent but located 2.8 cm deep. The best catheter choice is:

Answer: Ultrasound-guided long peripheral catheter (LPC)

A long peripheral catheter (LPC/extended dwell catheter) is appropriate for deep peripheral veins too superficial for PICC criteria but inaccessible with standard PIV length.

During real-time ultrasound guidance, the nurse sees the needle tip enter the vein lumen but cannot advance the guidewire. Which action should be performed FIRST?

Answer: Reposition the arm and reassess needle angle under ultrasound

Repositioning the arm and reassessing needle angle under live ultrasound can correct minor angulation issues that prevent smooth guidewire advancement.

Which ultrasound finding during post-insertion assessment best confirms that a PICC is NOT in the axillary or subclavian vein during an arm-based placement?

Answer: Absence of the catheter echo in the IJV on ultrasound

Scanning the IJV on ultrasound and finding no catheter echo confirms the PICC did not malposition into the internal jugular vein from the subclavian junction.