High frequency probe
Place only very light pressure on the probe
Have patient valsalva during placement
Isosceles triangle approach If you make distance to vein the same as the distance to insertion, then 45 degrees will get you there
if you want to take the time to figure out c then can get distance as well
Go a little higher on the IJ then you would think to get it before the branches
RCT of outcomes using landmark, static, an dynamic ultrasound (Crit Care Med 2005;33(8):1764)
210 patients in ED setting
if controlling for preplacement difficulty-
D OR for success 55 x higher than LM
S OR 3x higher than LM
uncontrolled success rates were (98%,82%,64%)
for first attempt success D 5.8 higher than LM, S 3.4 x higher than LM
unadjusted percentages were 62%, 50%, 23%
Article on its use in peds place probe above bone, enter below
(BR J Anaes 2007;98(4):509)
