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Figure 3.1 Catheter types: (A) multilumen, (B) large bore (e.g. dialysis, plasmapheresis), and (C) introducer.

Figure 3.2 Non‐occlusive thrombus in right internal jugular vein.

Figure 3.3 Depth scale set at 2.6 cm. Note that entry point to vessel is at 1 cm. The operator should be aware of these depths while performing the procedure.

Figure 3.4 Note the angle between the needle and ultrasound probe is 70–80°. This optimizes needle tip visualization and vein penetration. This angle is suggested for central venous access of the internal jugular, lateral subclavian (or axillary), and femoral veins.

Figure 3.5 Ultrasound of the guidewire. (A) Following cannulation of the vein the guidewire is passed through the introducer needle and the needle is removed. (B) The ultrasound is again placed at the insertion site to visualize the guidewire (C) and confirm that the guidewire is in the vein and not in the artery (D) before dilation of the vessel is performed.

Figure 3.6 Arterial line catheter types. (A) Longer catheter (12 cm) used for axillary or femoral arterial lines. (B) Shorter catheter (4.5 cm) used for radial arterial lines.

Figure 3.7 Arterial line catheter types. (A) Angiocatheter. (B) Assembly (needle, angiocath, and guidewire incorporated into a single unit). (C, D) Guidewire and introducer needle separately.

Figure 3.8 Introducer needle angles for arterial catheter insertion. (A) Axillary line cannulation with needle positioning shown at a steeper angle (70–80°). This steeper angle is used to improve visualization of the needle tip under ultrasound (not shown) in the larger axillary or femoral vessels. (B) Radial line cannulation with needle positioning shown at a more shallow angle (e.g. 45° or less) to avoid penetrating the posterior wall of this small artery.

Figure 3.9 Arterial line waveform with peak wave followed by dicrotic notch. An adequate waveform (e.g. not damped) should be confirmed before suturing the catheter in place.

Additional material for this chapter can be found online at:

www.wiley.com/go/mayer/mountsinai/criticalcare

This includes multiple choice questions and Videos 3.1, 3.2 and 3.3.