Slide 1: Approach to POCUS: Paracentesis. Marking epigastric vessels. The epigastric vessels run vertically along the anterior abdominal wall. The exact location varies from person to person. Graphic pointing to superior epigastric artery and vein, and inferior epigastric artery and vein. In patients with cirrhosis, the epigastric vessels can become distended. Injury to the epigastric vessels from paracentesis can cause life threatening bleeding.

Slide 2: 1. To mark the epigastric vessels, place the linear probe just lateral to the umbilicus in the trans-umbilical plane.

2. Set the depth so that you can see the abdominal wall and the ascites below.

3. Slowly move the probe laterally until you visualize the epigastric vessels. They look like small dark circles deep to the muscle/fascia.

4. You can use color doppler to confirm flow if you are uncertain.

5. Once you’ve found the vessels, mark the skin with a marking pen.

6. Slide the probe vertically to follow the course of the vessels and mark the vessels course.

In our next byte: learn how to use POCUS to identify a large fluid pocket!