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KEY IMAGES

Left lower quadrant (LLQ)

Orient probe longitudinally, and fan

Hand position for left lower quadrant

Right lower quadrant (RLQ)

Orient probe longitudinally, and fan

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Video 05-01: Free fluid in right lower quadrant

Free fluid and bowel can be seen in the RLQ of this video. Fanning through the fluid demonstrates the presence of bowel loops that were just out of the plane of view. While this is potentially accessible, it is preferable to access a space without bowel in the potential needle path.

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Hand position for right lower quadrant

Still image of measurements

Linear transducer vessel check

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Video 05-02: Vessel check with linear transducer

Changing to the linear transducer allows a much higher resolution evaluation of the soft tissue and peritoneum. This video shows the abdominal muscles, and clearly demonstrates a lack of vascular structures in the intended needle path.

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Real-time guidance of needle longitudinally

Only if necessary for a small pocket

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Video 05-03: Real time needle guidance

Using the longitudinal approach, the needle can be seen penetrating the peritoneum and being guided into the free peritoneal fluid in this clip. Using this technique allows much more confidence when accessing a small pocket of fluid

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Linear transducer vessel check, color Doppler

This is an advanced technique, no vessels seen

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Video 05-04: Vessel check with color Doppler

The color doppler and linear transducer reveal a small vessel in the subcutaneous space initially chosen for this procedure. The operator then quickly scans inferiorly and identifies an alternative site with no visible vessels.

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ACQUISITION TIPS

  • This procedure can be done either with ultrasound identification of a safe pocket followed by blind needle insertion, or under real-time guidance using a technique similar to vascular access (see Chapter 3).

  • Try sitting the patient up slightly and rotating to move bowel out of the way. Scan in both short and long axis.

  • Safe pockets are frequently in the RLQ and LLQ. The midline is described as a reasonable target, but a full ...

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