Ultrasound-Guided Vascular Access: In-Plane Approach

 

Ultrasound-Guided Vascular Access: In-Plane Approach

Needle Placement In-Plane
Figure 1: Needle placement in-plane with beam

The transducer is held stationary with the non-dominant hand while advancing the needle using the dominant hand.

The in-plane or long access approach is the technique used to allow visualization of the entire needle when performing ultrasound-guided vascular access.

In-Plane Approach
Figure 2: In-plane approach

The transducer is positioned in a long axis over the selected vein.  The vessel is visualized straight across the screen.  The needle is placed at the center of the transducer in-line with the ultrasound beam and the trajectory of the vessel with the bevel up.

Ultrasound Image of the Needle
Figure 3: Ultrasound Image demonstrating needle (yellow arrow)

To learn more about ultrasound-guided procedures, check out ultrasound-guided training courses from Gulfcoast Ultrasound Institute.

References:
Figure 2: Adapted from Chapter 19, Emergency Ultrasound Ed. 2, James Mateer MD, editor”

 

Word of the Day: Ultrasound-Guided Regional Anesthesia: In Plane-Needle Approach

Ultrasound-Guided Regional Anesthesia:  In Plane-Needle Approach

Needle placement in-plane with transducer - Images courtesy of John Antonakakis, MD
Ultrasound-Guided Regional Anesthesia: Needle placement in-plane with transducer/sound beam

The in plane or long axis needle approach is the technique used to allow visualization of the needle shaft and tip when performing ultrasound-guided regional anesthesia procedures.

The transducer is positioned over the selected nerve(s).  The needle is placed at the center of the transducer in-line with the ultrasound beam and the trajectory of the nerve bundle.

The transducer is held stationary with the non-dominant hand while advancing the needle using the dominant hand.

The needle shaft and tip are seen as a bright echogenic line.  The nerves are indicated by the yellow arrows.

To learn more about Ultrasound-Guided Anesthesia in plane-needle approach, and how to identify it during ultrasound-guided regional anesthesia and nerve block ultrasound courses, check out upcoming ultrasound-guided courses and products at Gulfcoast Ultrasound Institute.

Needle shaft and tip - Images courtesy of John Antonakakis, MD
Ultrasound-Guided Regional Anesthesia: Needle shaft and tip (red arrow), nerves indicated by yellow arrows.

 

 

 

 

 

 

 

Images courtesy of John Antonakakis, MD

 

 

Word of the Day: Free Hand In-Plane Musculoskeletal Injection Technique

Word of the Day: Free Hand In-Plane Musculoskeletal Technique

Musculoskeletal injections performed using ultrasound guidance allows for efficient and accurate needle placement that results with reduced complications and improved patient satisfaction.

There are two basic approaches used when performing ultrasound-guided Musculoskeletal injections:  In-plane and out of plane.

The “in-plane” approach is the most commonly utilized technique because it allows better visualization of the needle.   To perform the in-plane approach, the needle is position in the center of the probe in a long axis position and advanced parallel to the sound beam.  The goal is to always see the entire length of the needle, including the tip.

Needle in Musculoskeletal in-plane technique

To learn more about Free Hand In-Plane Musculoskeletal Injection Technique, and how to identify it during your evaluations, check out upcoming musculoskeletal online training course or other Musculoskeletal courses that will provide hours of hands-on scanning.

Ultrasound-Guided Regional Anesthesia

by Bret P. Nelson, MD, RDMS, FACEP

Ultrasound-guided regional anesthesia (UGRA) is an emerging application of point-of-care sonography. Once solely the purview of anesthesiologists, other specialists are now realizing the benefits of these procedures and gaining competency in their performance.

Two recent review articles summarize key blocks nicely:

  • De Buck F, Devroe S, Missant C, Van de Velde M. Regional anesthesia outside the operating room: indications and techniques. Curr Opin Anaesthesiol. 2012 Aug;25(4):501-7 (PMID: 22673788)
  • Antonakakis JG, Ting PH, Sites B. Ultrasound-guided regional anesthesia for peripheral nerve blocks: an evidence-based outcome review.Anesthesiol Clin. 2011 Jun;29(2):179-91. (PMID: 21620337)

Ultrasound-Guided Regional Anesthesia Landmark approach

Traditionally, the only method for performing procedures was using anatomic landmarks. For example a femoral nerve block would be performed by first locating the femoral crease and then palpating the pulse of the femoral artery. The needle would be inserted lateral to the femoral artery.

Nerve Stimulator approach

Use of the nerve stimulator increased success rates and the ability to perform more difficult blocks. When using a nerve stimulator the needle is still attached to a syringe of anesthetic solution. However it is also attached to a nerve stimulator which creates a mild (typically less than 0.5 mA) current. Position of the needle tip is confirmed by muscle twitch. For example, quadriceps muscle twitch when performing a femoral nerve block.

In the past decade many providers have moved from nerve stimulation to ultrasound guidance, in part due to data studies such as this one:

  • Abrahams MS, Aziz MF, Fu RF. et al. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth 2009 Mar;102(3): 408-417 (PMID: 19174373)

Ultrasound guidance

Most recently ultrasound guidance has become the method of choice for many clinicians performing regional nerve blocks. It can be used alone or in combination with nerve stimulation. In the video below the femoral artery is seen pulsating to the screen right; to the screen left a growing anechoic space represents anesthetic being infiltrated around the femoral nerve. Note that in this video the operator is using a nerve stimulator in addition to ultrasound guidance.

Common Blocks

There are a number of nerve blocks commonly employed in acute care and operative settings. Many are reviewed on NYSORA’s website. Here are a few to consider if you are new to the technique:

  • Femoral nerve block: Helpful for femur, knee, thigh injuries
  • Forearm block: helpful for hand injuries
  • Interscalene brachial plexus block: helpful for shoulder, humerus, elbow injuries

For further information regarding nerve blocks please check out the resources listed in this post, as well as the anesthesiologists, emergency physicians, pain management and/or sports medicine physicians at your local institution. To learn more about Ultrasound-Guided Regional Anesthesia, check out the upcoming courses by Gulfcoast Ultrasound Institute.

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