Instructions

Parasternal Window

The Parasternal Window consists of a set of views obtained with the transducer placed at the left sternal border. The patient is placed in a steep left lateral decubitus position with the left arm extended above the head in a relaxed position. The first image (PLAX view) is obtained with the transducer just left of the sternum, between the 3rd or 4th intercostal space. The image marker is directed toward the patient’s right ear. All other images of the parasternal window are made by angling and/or rotating the transducer. Be prepared to make adjustments in the position, angle, and rotation of the transducer to optimize the image. Additionally, adjustments in the patient’s position such as, rolling forward or back maybe necessary.

Apical Window

The family of views obtained from the Apical window is obtained with the patient in a steep left lateral decubitus position. A mattress cut out is very helpful in positioning the transducer in this area. To begin, find the patient’s maximum pulse by palpating the area between the 4^th and 5^th intercostal space, parallel with the left mid clavicle. To obtain the first image (Apical 4 chamber view) the image marker is directed toward the bed. All other images of the apical window are made by angling and/or rotating the transducer. Be prepared to make adjustments in the position, angle, and rotation of the transducer to optimize the image. Additionally, adjustments in the patient’s position such as, rolling forward or back maybe necessary.

Subcostal Window

The family of views obtained from the Subcostal window is obtained with the patient lying supine. It may be helpful to relax the abdominal muscles by having the patient bend the knees. The transducer is placed just below the xiphoid process. The image marker is directed toward the patient’s left shoulder and the sound beam is angled slightly anteriorly. Having the patient suspend inhalation will greatly assist in obtaining images from this region. All other images of the subcostal window are made by angling and/or rotating the transducer. Be prepared to make adjustments in the position, angle, and rotation of the transducer to optimize the image.

SN Window

Views obtained from the Suprasternal window is obtained with patient lying supine. The patient’s next should be relaxed with a slight upward tip of the chin. Moving the chin slightly to one side may also help open up the notch space. Place the transducer in the notch with the image marker toward the patient’s left ear. Direct the sound beam inferior to obtain the structures for the first image (LAX of the aortic arch). All other images of the suprasternal window are made by angling and/or rotating the transducer. Be prepared to make adjustments in the position, angle, and rotation of the transducer to optimize the image.