Bringing Solutions to Vascular Medicine
ML2303 Rev A 10/10
1. Basic access Anatomy
2. Basics of Ultrasound
3. Smart Needle
3 main access sites
1. Femoral
2. Radial
3. Brachial
Femoral
1. Advantages
a. More comfortable for Dr.
b. Bigger Artery or vein
c. Less chance for Spasm
2. Disadvantages
a. PVD
b. Anatomical variances
c. Can lie deep in the leg
d. Complications tend to be worse
Femoral Head
N A V
Radial/Brachial
1. Advantages
a. Great for the patient
b. Much more superficial
2. Disadvantages
a. Awkward
b. Spasm
Ultrasound
Two Types
1. Doppler
2. Duplex
Doppler
• Uses sound which can be heard and seen as
an M-mode Image
1. Arterial
2. Venous
Arterial
Venous
Duplex
• Uses Gray scale and color to calculate
and create a picture on the screen
Duplex
Continuous auditory
feedback to aid in locating
vascular structures
Description
• Vascular access device for arteries
and veins using percutaneous
doppler (sound) guidance
• Components:
– Reusable monitor that amplifies
audible, vascular sounds and acts
as a speaker
– Single-use needle with an inner
detachable probe (stylet) that acts
as a microphone
Basic Concept
• Detect veins and arteries by the sound of flowing blood
• Artery sound will be pulsatile (whoosh, whoosh)
• Vein sound will be more constant (“windy” or static)
• Needle should be directed toward desired sound (artery or
vein)
Components
Monitor
-- battery powered
(reusable)
Needle
-- contains the Doppler probe stylet
(disposable)
Additional items required: Syringe & sterile saline
Monitor
• “Speaker” for transmitting sound
• Uses continuous wave doppler
• Operates using 6 standard AA
alkaline batteries (provides 20 hours
of “on time”)
• Can be used on or off the sterile field
Simple Monitor Mechanics
Three simple controls:
– On/off button
– Mute button
– Volume control (1-5)
Needles
• Needles consist of a doppler probe
at the end of a stylet that is housed
within the standard sized needle
• Stylet connects to monitor via
cable attachment
• Needles and connection are
proprietary – no other needle works
• Needles are single use
Doppler Probe
Tip of needle
3 Types of Needles
1. Bare Needle
– Regular Length
– Extended Length
2. IV Assembly Sheathed Needles
3. Catheterization Sets
1. Bare Needles
• Standard percutaneous entry
needle with probe stylet inside
• Available in 18, 20, and 22 gauge
sizes with differing lengths
2. I.V. Assembly
Sheathed Needles
• Two Components:
– Needle with doppler probe stylet
– I.V. catheter available in
polyurethane or Teflon
• Available in I.V. catheter sizes
20, 22, 24 gauge (10 to a box)
3. Catheterization Sets
• Three Components:
– Needle with doppler probe stylet
– Polyurethane or Teflon coated
catheter
– Positive Placement Spring-wire
guide
• Available only in 20 gauge catheter
size (10 to a box)
Clinical Use
• Used to assist during
difficult arterial or venous
access cases
• Used to aid in the access of
small vessels
Procedure Set-Up
1. Attach cable from needle to monitor
Use in Sterile Field
• Monitor can be placed on or
off the sterile field during
the procedure
• If used on the sterile field,
enclosed sterile bag goes
over the monitor
Testing
2. Test needle by dipping in saline
(Audible signal should be heard)
Flushing the Needle
3. Attach saline syringe and flush the needle
(VERY important)
Puncture
4. Insert tip of the SmartNeedle into tissue at a 45 degree angle
and inject a small amount of saline to clear any air bubbles
Clinical Procedure
5. Move needle in a circular
motion listening for
appropriate audible doppler
sound
6. Puncture when appropriate
audible sound is heard
NOTE: Bleedback often will be
absent until doppler probe
stylet is removed from needle
Clinical Procedure
7. Withdraw the probe stylet, leaving the needle in place
Troubleshooting
• Signal is absent when monitor is
turned on?
– Check “mute” button
– Replace batteries
– Was it dropped?
– If unable to correct, contact
VSI customer service
Troubleshooting
• No sound?
Air bubble may be on tip.
Solution = inject saline through
needle to expel any air bubbles
• Signal disappears?
Needle may have compressed
the vessel.
Solution = pull back needle
slowly
Benefits
1. Quicker vessel access in difficult femoral cases
= improved procedure room efficiency and quicker turnaround
2. Minimize the “pin cushion” effect, which can
cause trauma to surrounding structures
3. More secure access in challenging patients
(small vessels, large patients) where visual ultrasound
is challenged
Continuous auditory
feedback to aid in locating
vascular structures
Use of the SmartNeedle devices are indicated when blood flow must be detected for percutaneous vessel
cannulation. The vessel must be of a caliber which would normally be punctured with a needle and/or catheter
of this size or larger.
CAUTION: Federal law (U.S.A.) restricts these devices to sale by or on the order of a physician.
Please see the appropriate product Instructions for Use for a complete listing of the indications,
contraindications, warnings and precautions.
SmartNeedle is a trademark of Vascular Solutions, Inc. ©2010 Vascular Solutions, Inc. All rights reserved.