Using ultrasonography, evaluate the common femoral (or, if required, the right internal jugular) vein for patency and compressibility. If there is any thrombus or indwelling catheter, the approach may need to be altered. Clean and drape the site. Anesthetize the skin using appropriate anesthetic agent. Conscious sedation may be utilized depending on the clinical status of the patient. Avoid over sedation since patient cooperation and breath holding are imperative for good quality imaging.
Access the femoral (or right internal jugular) vein using the standard venous puncture protocol. Ultrasonography may be used as an adjunct, if needed. Sheath placement depends on operator preference.
Studies have shown high success rates with ultrasound-directed catheter pulmonary angiography for thrombolysis in massive and submassive pulmonary embolism.