Step 1: Field Preparation
As with any procedure or surgery in medicine, the key to success starts
with the preparation phase before the patient’s skin is touched by a
needle or scalpel. For ultrasound access, visualization is of utmost
importance. Thus, the operator should drape the surgical field making
sure that the clavicle is exposed up to its superior edge and that there
is enough room available to create an adequate pocket. Having the
clavicle within the field of view ensures the ability to image the
axillary vein on ultrasound medially until it disappears under the
shadow of the clavicle to become the subclavian vein. This gives the
operator the ability to choose how medial or how lateral the access
sites will be in relation to the clavicle (Video 1).
After the rest of the surgical draping is complete, the ultrasound probe
should be dropped by an assistant into a sterile sleeve containing
ultrasound gel held by the operator and then secured to the drape near
the access site. The ultrasound machine should be placed where the
operator can easily view the screen without having to strain or look
over any obstacles. This is usually at the head of the bed or across the
bed from the operator. All access wires should be within easy reach to
minimize the operator’s movements once access is obtained with the
needle.