Advanced Needle Visualization

[epidural man]

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Sonosite has an upgrade to their ultrasound which allows good needle visualization at needle angles up to 50-60 degrees - so they claim.

Has anybody had real experience with this new technology? Is the software upgrade worth whatever they are charging?

 

[C.P.]

I've been using it.
It works pretty well, actually.
The physics involved are a change in the angle that the ultrasound wave is emitted and can help give you better visualization at more steep angles (or even normal angles of insertion).
It's made needle visualization a lot easier, especially when I'm teaching people less experienced in using an ultrasound.

 

[Idiopathic]

seems like this would affect your target image since we are still dealing with 2-d space. the only times i see problems with visualization are in SCB, so i recommend using the 4inch needle and taking a shallower approach angle, and ICB, where I prefer the small curvilinear probe. it really is all technique otherwise.

 

[epidural man]

seems like this would affect your target image since we are still dealing with 2-d space. the only times i see problems with visualization are in SCB, so i recommend using the 4inch needle and taking a shallower approach angle, and ICB, where I prefer the small curvilinear probe. it really is all technique otherwise.

There are lots of blocks that will require a steeper angle because of anatomy (bones in the way) and entering away from the probe will not help (i.e. piriformis, paravertebral, lumbar plexus, stellage ganglion) just to name a few. Also, if you can use the linear probe rather than the C11x (small curvilinear), the image quality is much better.

Apparently it doesn't affect your target image - but that is why I asked the question. The reps say that the image quality doesn't suffer.

 

[pgg]

I think it's pretty good, and worth however much of someone else's money they spent to get it.

Haven't used it much, since the hospital that bought it has anti-regional orthopods. But I thought it worked well the few times I have used it. A lot less effort to get the needle exactly in plane and visible.

 

[Idiopathic]

There are lots of blocks that will require a steeper angle because of anatomy (bones in the way) and entering away from the probe will not help (i.e. piriformis, paravertebral, lumbar plexus, stellage ganglion) just to name a few. Also, if you can use the linear probe rather than the C11x (small curvilinear), the image quality is much better.

Apparently it doesn't affect your target image - but that is why I asked the question. The reps say that the image quality doesn't suffer.

i dont use ultrasound for any of the blocks in bold. maybe thats why i dont appreciate the value as much.

 

[dhb]

The physics involved are a change in the angle that the ultrasound wave is emitted and can help give you better visualization at more steep angles (or even normal angles of insertion).

I think it's more a selective analysis of the reflected echos from the area where the needle is supposed to travel through. GE also has this software application but i can't comment on it's use since i had good visualization i forgot to use it.

 

[Oggg]

yeah I'd also like to know. The reps showed it to me for about 30 seconds before they had to leave. It's like $3000 or something. The alternative is Havel's or PAJUNK echogenic needles, which are a couple of dollars more than the regular non-echogenic needle. If my hospital doesn't buy us a new Sonosite with HFL and needle software, I think we're going to go with echogenic needles.

 

[proman]

Is this new tech really that helpful? I had trouble seeing the needle when I first started using US but with experience and better understanding of ultrasound I haven't had issues seeing the needle. And that's using regular needles or Stimuplex. I know I'm not special, it just takes good technique.

 

[Oggg]

If you search on Youtube, there is a Sonosite video on Advanced Needle Visualization. There's a Dr. Auyong from WA and Dr. M Lee from UCSF doing the testimonials. The demo clips in the youtube video show some situations where the needle can't be seen, then they toggle the ANV on, and suddenly there is this flaming needle on the screen. They didn't show any needle angles steeper than 50 degrees. They also talk about it being "great for teaching". IMHO the best teaching is to make someone use the L38 probe with regular needles til they get good.

Interestingly, on the U-Blok website, they show Havel's and PAJUNK echogenic needles easily seen at angles greater than 50.

 

[pgg]

IMHO the best teaching is to make someone use the L38 probe with regular needles til they get good.

Wouldn't the best teaching be to make people use the landmark & paresthesia technique?

 

[IN2B8R]

Wouldn't the best teaching be to make people use the landmark & paresthesia technique?

No.

 

[pgg]

No.

🙂 Obviously not. The point I was attempting to make is that withholding current tools and technology from trainees does not necessarily improve the quality of the training.

 

[epidural man]

There's a Dr. Auyong from WA....

Dr Dave Auyong is at VM in Seattle. He is getting lots of money to say it works great. I just wonder if it actually does - and if anyone doesn't need it - it is Dave. Speaking of Dave, check out this video I uploaded some time back of him using ultrasound to put in an IV. Me thinks it is the coolest IV ultrasound video ever.

http://www.youtube.com/watch?v=fie9DI8lV3M

Interestingly, on the U-Blok website, they show Havel's and PAJUNK echogenic needles easily seen at angles greater than 50.

I have used different "echogenic needles" and I think they all suck - a 20g tuohy works just as well if not better.