…because of the cosmesis, often with antibiotic prophylaxis. Deep puncture wounds , where the base cannot be inspected or irrigated clean. Wounds with retained foreign material…

…after arterial puncture, technically more difficult with ultrasound Femoral vein Fastest, and does not interfere with ongoing CPR or airway management, no risk of pneumothorax…

…or to resolution of the underlying cause. Contraindications Hypothermia with a body temperature below about 30 °C — the hypothermic myocardium is irritable and pacing can…

…roots of the cauda equina. If in doubt: choose a level lower, never higher. 3. Mark the puncture site, clean in wide circles and apply…

…punctured. Identify the diaphragm, the liver or spleen, the lung and the fluid level. 2. Choose a point with at least 15 mm depth of…

…the puncture went. Indications Unexplained cytopenia in one or more cell lines. Suspected acute leukaemia, myelodysplastic syndrome or myeloproliferative neoplasm. Work up and staging of…

…50 mL syringe for a knee with a large effusion, 5–10 mL for smaller joints. Local anaesthesia of the skin and subcutis where needed…

…the left lower quadrant. Confirm at least 2–3 cm of free fluid depth with no bowel in the path of the needle and measure…

…In shock with collapsed vessels, the antecubital fossa or the external jugular vein are the vessels that can most often still be punctured — and ultrasound…

…and note the direction. Disinfect and allow to air dry. 2. Anaesthetise the skin with a small amount of lidocaine without adrenaline (epinephrine). 3. Puncture…