Any good resources to improve needle driving/manipulation?

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Blitz2006

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Just wondering if you know of any good books, videos, resources that can help improve technique with needle driving/manipulation under fluoro?

While in fellowship, roughly how long did it/does it take to get "comfortable" with driving a needle with accuracy under fluro?

2 weeks? 2 months? 6 months?

Thanks!
 
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Blitz2006 said:
Just wondering if you know of any good books, videos, resources that can help improve technique with needle driving/manipulation under fluoro?

While in fellowship, roughly how long did it/does it take to get "comfortable" with driving a needle with accuracy under fluro?

2 weeks? 2 months? 6 months?

Thanks!
Click to expand...

Best resource is live patients. You can read about techniques and clinical pearls all day but it’s no replacement for doing it. A cadaver course would be the next best thing but they don’t move or contract their muscles like a real patient will (at least not at the reputable courses).

Time to get comfortable will vary depending on volume and not really reliable anyway because there’s the time until you’re comfortable and then the time until your attending is comfortable.
 
are you bending the needle? Bend the tip with the plastic sheath that it comes packaged in.
 
I think Fenton text has a chapter. As a resident I poked chicken and steak under Fluoro after hours.

Like everything else walk before u run. Shorter larger gauge needles to start then move on from there.

I was very lucky to have a young at the time but now well known mentor in residency. Ask lots of questions of your junior faculty. Don’t be embarrassed to be forward. Now is your time to ask dumb questions.
 
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Cadaver workshops are gold when you’re a fellow and you want more experience and practice

Stryker has rfa ones, all SCS companies have them, and of course sis/Asra have them for a fee. After a while itll become second nature, but the workshops were invaluable to me when I was trainig
 
i dont bend the needle. tried it both ways, but i find that the bend kinks too easily when you hit bone. some say they have more needle control with the bend, but if you start at the right place, a straight needle can get anywhere.
 
SSdoc33 said:
i dont bend the needle. tried it both ways, but i find that the bend kinks too easily when you hit bone. some say they have more needle control with the bend, but if you start at the right place, a straight needle can get anywhere.
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I only bend the needle when my target is far/deep or there may be need to manipulate the tip to slip into a narrow space. When bending the tip, I never touch the tip with glove or even sterile gauze, I like to use a syringe hole as a sterile fulcrum to bend the needle.
 
You will need to bend your longer needles(3-6 " needles)..... if u hit bone you are stopping and redirecting unless you are doing a core decompression or stem cell, so this shouldnt be a reason to not bend. Yea a straight needle can and will go anywhere sometimes before the intended target, which means more pain for the patient and longer procedure and fluoro time for you. It is a must have in your tool box.
 
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The difficult part is more the fluoroscopy than the needle driving itself.

I have tried practicing with ultrasound phantoms so you can see how much a needle moves, but you really need to have a hunk of meat and a C-arm if you're going to practice. The hunk of meat/fruit/phantom is easy to get on it's own, but the feedback of where is the needle is and how it looks based on the angle of the C-arm is harder to recreate.
 
I suggest using a bent tip needle, but the real key here is that you have a consistent angle in your bent tip needles, this enables muscle memory. If you bend the needle yourself, the angle will certainly be different by a degree or two needle to needle, and this will prevent you from developing good muscle memory. That said, I bend my own needles due to cost, but for learning purposes, having pre-bent needles at the same exact angle every time will help you.
 
nvrsumr said:
I think Fenton text has a chapter. As a resident I poked chicken and steak under Fluoro after hours.

Like everything else walk before u run. Shorter larger gauge needles to start then move on from there.

I was very lucky to have a young at the time but now well known mentor in residency. Ask lots of questions of your junior faculty. Don’t be embarrassed to be forward. Now is your time to ask dumb questions.
Click to expand...
Great tips.

I'm not sure how feasible it is for me to use C-arm after hours...did you pay a tech to stay after hours?!

I'm having difficulty with stuff like conventional RF, like knowing once I hit Os which way to turn, "loop over" to catch the medial branch...

Also just general stuff like redirecting needle for Lumbar TFESIs to get the perfect placement...

Is this normal to have trouble? Or am I "slow"

Sent from my SM-G955U using Tapatalk
 
Blitz2006 said:
Great tips.

I'm not sure how feasible it is for me to use C-arm after hours...did you pay a tech to stay after hours?!

I'm having difficulty with stuff like conventional RF, like knowing once I hit Os which way to turn, "loop over" to catch the medial branch...

Also just general stuff like redirecting needle for Lumbar TFESIs to get the perfect placement...

Is this normal to have trouble? Or am I "slow"

Sent from my SM-G955U using Tapatalk
Click to expand...

It is normal to have trouble. Give it some time. I did not "get" everything until I was a pain attending for about 6 years.
 
the needle knows......not sure how it does. Here is a decent video. The only thing he forgot was the alcohol after the betadine.....and i didnt see him use contrast.

 
I feel you -- I was in your shoes last year. What got me more comfortable was volume, volume, volume. The more you do, the more confidence you get. Around the 6 month period, something clicks and you feel much better about your skills.

I bend my needles. I also took some needles home and used a block of tofu to practice driving. I'd insert the needle on one end and use a pen mark to indicate where I wanted the needle to exit on the other end. Try to get as close as you can to that mark. It's not the same as skin/tissue, but it did help. Can also use a piece of uncooked chicken
 
Doctodd said:
the needle knows......not sure how it does. Here is a decent video. The only thing he forgot was the alcohol after the betadine.....and i didnt see him use contrast.

Click to expand...


Just watched video. No chlorhexidine/alcohol, no contrast, single view only, particulate steroid. Not impressive.
 
A LOT wrong with that video. But someone who only looks superficially would think it is “good”.

Beta dine prep ok but supposed to wait what like 3 min. Pokes patient twice for local. Not horrible but could be avoided.

Does get oblique then lateral but doesn’t needle look very superficial particularly given that patient is not skinny.

He does give contrast but that image is without contrast on it. Did he get an intravascular injection? No live fluoro - and if he did, it would have shown his fingers. No pigtail/t piece - that needle is blowing in the wind as he switches needle and screws on injection needle.

Particulate med used for injection. No lateral. Wipes off injection site with dirty drape. Gives leading statement about shooting down leg....
 
i only briefly watched....i should have said it was a decent video showing a bent needle.....glad the other guys dissected it for the forum
 
Ducttape said:
A LOT wrong with that video. But someone who only looks superficially would think it is “good”.

Beta dine prep ok but supposed to wait what like 3 min. Pokes patient twice for local. Not horrible but could be avoided.

Does get oblique then lateral but doesn’t needle look very superficial particularly given that patient is not skinny.

He does give contrast but that image is without contrast on it. Did he get an intravascular injection? No live fluoro - and if he did, it would have shown his fingers. No pigtail/t piece - that needle is blowing in the wind as he switches needle and screws on injection needle.

Particulate med used for injection. No lateral. Wipes off injection site with dirty drape. Gives leading statement about shooting down leg....
Click to expand...

super superficial. got to be fake. FAKE NEWS!
 
Understanding parallax error helped me greatly in my fluoro needle guidance. I try to keep the target in the very center of the II. If not in the center as can be the case with multiple targets, understand the deep target is closer to the center than it appears on the skin and it will appear to move toward or away from the center when raising or lowering the table or c-arm. I wish I had a pic to show this, but imagine the x-rays are not parallel, they fan out.
 
Rathmell's procedure book has a very good chapter up front about radiation safety, getting good imaging results and needle techniques. I practiced with a spinal needle in a block of foam when I first started, just getting the feel for it. I think the hardest skill to learn is getting the gun barrel view with the needle early so you can advance the needle accurately after that, and you can practice this even without fluoro just looking at angles. I also practiced with the C-arm and a piece of meat with the bone still in to practice accuracy and "walking off".
 
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