Start with cardiac/phased array probe

Set machine to cardiac preset

Hold probe like a pencil

Place probe on patient’s left chest, just lateral to the sternum within the 3rd - 5th intercostal spaces.

Orient probe maker to patient’s right shoulder

While watching the screen, start moving the probe from this point slowly spreading out in all directions, making larger movements as you go. Watch the screen the entire time. Watch the heart move in and out of view as you pass over ribs and lung.

Identify the best cardiac window and anchor the probe. Add firm pressure and feel the probe shift into the intercostal space. Stabilize your position by placing your wrist on the patient’s body.

To fully optimize the view, make slow deliberate movements, tilting and rocking the probe in all directions (Mortar and pestle movements)

Focus the mitral value leaflets at the center of the screen and rotate clockwise or counter-clockwise to open up the LVOT.

Max out depth to look for pleural effusion then reduce depth to place descending aorta at the bottom of the screen.

Tips

• To help with difficult views, roll patient to left side

• If possible, work with patient on breath holding at various points of respiratory cycle

• COPD will shift heart inferiorly

Starting from an optimized standard view, tilt probe inferiorly to bring the RV and RA into view.

Rotate clockwise and counterclockwise to optimize view

Tips

• If possible, work with patient on breath holding at various points of respiratory cycle.

• with small movements, slide the probe in all directions to optimize image.

Starting from an optimized standard view, tilt probe superiorly to bring the RV and RA into view.

Tips

• If possible, work with patient on breath holding at various points of respirator cycle.

• with small movements, slide the probe in all directions to optimize image.