Favorite fluoro “pointer”

[camkiss]

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What is your favorite pointer to lay on the skin during a fluoro injection to mark your local entry point? I used the scissors from suture removal kits but they’ve been out of stock off and on lately. Blunt tip needles seem to roll on certain body habitus. Curious what y’all are using.

 

[MitchLevi]

Blunt tip or the needle attached to my local anesthetic.

 

[au bon pain]

Bend the blunt

 

[BobBarker]

Lay the spinal needle on the patient

 

[callmeanesthesia]

I use the 18g fill needle. If it’s in a sloped area where it might roll off, I stick it through the edge of a 4x4 to prevent it from sliding off. Or I hold the spinal needle as a pointer, and keep my hand out of frame.

 

[DubVille]

Bend the blunt 20g I use to draw up meds. May use forceps if it rolls off.

 

[Taus]

What is your favorite pointer to lay on the skin during a fluoro injection to mark your local entry point? I used the scissors from suture removal kits but they’ve been out of stock off and on lately. Blunt tip needles seem to roll on certain body habitus. Curious what y’all are using.

Bent 18g

 

[pjuer]

What is your favorite pointer to lay on the skin during a fluoro injection to mark your local entry point? I used the scissors from suture removal kits but they’ve been out of stock off and on lately. Blunt tip needles seem to roll on certain body habitus. Curious what y’all are using.

I had a collection of those Medtronics tunneling tools with the sharp tip unscrewed. Had them sterilized and used in office and hospital

 

[pmrmd]

^This. Tunneler tools.

 

[runfastnow]

Bent 18 gauge on old/large habitus spines.
25 gauge attached to local for young/small spines.

If using 25 gauge for MBBs or ESI don't even need a pointer. Just use the 25 gauge 3.5" without local and people tend to do fine.

 

[pastafan]

Used an OR skin marker to make a dot. Never moved.

 

[SSdoc33]

great thread topic:

try this: use a 10mL syringe, and pull the plunger all the way out to the hilt. then, attach the 18g needle that you use to draw up meds. this gives you about a foot of reach to keep your hands out of the frame. you use the pointer in your left and then can simultaneously start the injection with your right. no need to turn your back to drop the stuff back on the sterile tray. this come is handy particularly for MBBs. point with your left, take a pic, dive into the skin, then move to next level, point with your left take a pic, dive into the skin, etc.

the good part about this is you are not really wasting anything (other than a cheap 10mL syringe) and you dont need to have any separate equipment sterilized/autoclaved. it will also save you a bunch of radiation b/c you will be taking fewer shots this way

 

[mid|ine]

great thread topic:

try this: use a 10mL syringe, and pull the plunger all the way out to the hilt. then, attach the 18g needle that you use to draw up meds. this gives you about a foot of reach to keep your hands out of the frame. you use the pointer in your left and then can simultaneously start the injection with your right. no need to turn your back to drop the stuff back on the sterile tray. this come is handy particularly for MBBs. point with your left, take a pic, dive into the skin, then move to next level, point with your left take a pic, dive into the skin, etc.

the good part about this is you are not really wasting anything (other than a cheap 10mL syringe) and you dont need to have any separate equipment sterilized/autoclaved. it will also save you a bunch of radiation b/c you will be taking fewer shots this way

Exactly what I do

Also, the larger and denser the pointer, the more it will mess with your flouro image and increase output from the c-arm

 

[lobelsteve]

Just wing it you sissies, it's how you get at steering.

(I use the 20g drawing up needle and drop it on field after meds in syringes.)

 

[gaspasser127]

When using a 25G needle for injections do you guys localize the skin?

 

[kstarm]

When using a 25G needle for injections do you guys localize the skin?

No. Unless patient specifically requesting and after we discuss how it is more pokes and may not make that much difference, or if 1st MBB they complained a lot of injection site pain and were moving around a lot.

 

[DOctorJay]

When using a 25G needle for injections do you guys localize the skin?

No

I use the 18g needle dropped on the skin as a marker

Occasionally will do that syringe technique as well

 

[Ducttape]

Just stab the patient with a needle and then sort things out afterwards.

/sarcasm off.

 

[Ferrismonk]

I use 25G for almost everything. Only use skin local for RF where I use a 20G cannula.

My hospital buys us little single-use metal pointers, but in the private clinic I like to use hemostats that we resterilize. I hook the loop of the stat on my ring finger and I can flip it back and forth as needed while using my other fingers to steer the needles.

If I'm lazy or I drop my metal pointer thingy, I'll use the afore mentioned 10mL syringe with the plunger withdrawn and the 18G attached.

 

[RaceCanyon]

18 gauge draw up needle with a little steri strip flag. Never moves, and I can take as many steps back as I need

 

[deleted131481]

I use bent 18g as mentioned above. I use the tip and the bend as markers which is often close enough to the distance between 2 mbbs so I can get 2 targets with one pointer image.

 

[deleted131481]

Also, I sometimes palpate PSIS or iliac crest quickly to get a better idea for my initial image.

 

[DrMDAware]

@ragnathor @Taus @DubVille and others…The bent 18 gauge or 20 gauge seems neat. I’m still having trouble how people are using it. Could anyone post a picture? Thx.

 

[lobelsteve]

Place it on skin and take a scout view.
Move it so the tip is where you want to inject.
Inject there.

 

[Ducttape]

i dont need a pointer per se, i hold the procedure needle in 1 hand, the anesthetic needle in the other after the scout film.

 

[kstarm]

i dont need a pointer per se, i hold the procedure needle in 1 hand, the anesthetic needle in the other after the scout film.

This is what I do too

 

[DrMDAware]

I use bent 18g as mentioned above. I use the tip and the bend as markers which is often close enough to the distance between 2 mbbs so I can get 2 targets with one pointer image.

Could you please share a photo with me? Thanks

 

[callmeanesthesia]

Robot or human?

Stainless steel chopsticks. Dirt cheap and durable. Could probably autoclave them. Long enough to hold one end with your hand out of the beam, and could probably even hold 2-3 at once if you practice.

 

[deleted875186]

I use the 18g fill needle. If it’s in a sloped area where it might roll off, I stick it through the edge of a 4x4 to prevent it from sliding off. Or I hold the spinal needle as a pointer, and keep my hand out of frame.

Will typically lay 2-3 needles down at once, take a shot, usually close enough, and then inject in all locations for local at once, helps to cut down on fluoro time, can steer the needle so you don’t need to be that precise. I spend much more time lining things up for an RFA.

 

[callmeanesthesia]

Will typically lay 2-3 needles down at once, take a shot, usually close enough, and then inject in all locations for local at once, helps to cut down on fluoro time, can steer the needle so you don’t need to be that precise. I spend much more time lining things up for an RFA.

For MBB I lay the 18g fill needle parallel to the spine so the top of the needle is over L4 pedicle and bottom is near L5, then I put one of the 25g 3.5” needles so the point is near the sacrum.

 

[oreosandsake]

18G stuck through the end of the plastic straw tube that the spinal needles or RF cannulas come in.

 

[oreosandsake]

18G stuck through the end of the plastic straw tube that the spinal needles or RF cannulas come in.

i take home what I don't use. it's not because I'm a hoarder. the medical waste we produce is horrible. I am trying to re-purpose things we throw away constantly. if you use cotton drapes, and they come in packs of 4, and you dont contaminate them you can take them home and use them as house rags or to wash your car. the sticky drapes can be useful for dining out with young messy children. dont open what you dont need etc etc

 

[lobelsteve]

i take home what I don't use. it's not because I'm a hoarder. the medical waste we produce is horrible. I am trying to re-purpose things we throw away constantly. if you use cotton drapes, and they come in packs of 4, and you dont contaminate them you can take them home and use them as house rags or to wash your car. the sticky drapes can be useful for dining out with young messy children. dont open what you dont need etc etc

Those blue OR towels are “gifts” for the patient after RF. I have some patience come for the RF just for the towels.

 

[Ligament]

18G stuck through the end of the plastic straw tube that the spinal needles or RF cannulas come in.

This is what I do for cervical RF. Otherwise I just lay the 18ga on the patiient minus the plastic straw tube. In fact, just did this minutes ago.

 

[Ligament]

Robot or human?

Stainless steel chopsticks. Dirt cheap and durable. Could probably autoclave them. Long enough to hold one end with your hand out of the beam, and could probably even hold 2-3 at once if you practice.

I'm confused; you are using them as pointers without autoclaving them? I have an H-mart I get grrocery's at before clinic once a week and can pick them up dirt cheap.

 

[callmeanesthesia]

This is what I do for cervical RF. Otherwise I just lay the 18ga on the patiient minus the plastic straw tube. In fact, just did this minutes ago.

You’re doing procedures at 5:00 on a Saturday?

 

[callmeanesthesia]

I'm confused; you are using them as pointers without autoclaving them? I have an H-mart I get grrocery's at before clinic once a week and can pick them up dirt cheap.

I don’t use them - I just use the 18g. But I have a partner who uses one to mark the patient before he gloves up and preps.

 

[Ligament]

You’re doing procedures at 5:00 on a Saturday?

Till 7pm every sat.

 

[RoloTomassi]

What's your schedule like?

 

[oreosandsake]

This is what I do for cervical RF. Otherwise I just lay the 18ga on the patiient minus the plastic straw tube. In fact, just did this minutes ago.

Yup. Me too. Exactly what I do.

 

[oreosandsake]

Those blue OR towels are “gifts” for the patient after RF. I have some patience come for the RF just for the towels.

Kickback for Medicare patients! Watch out for those whistle blowers! 😂

 

[oreosandsake]

Till 7pm every sat.

Business is good when you’re a good doctor 💯

 

[SC Tian]

I use spinal tap tube attached to a 18 g needle with cap, my hand is completely out of injection field.

 

[geauxg8rs]

Till 7pm every sat.

My wife is pissed if I look at my upcoming schedule on the weekend

 

[deleted131481]

Could you please share a photo with me? Thanks

Here's one. The bend and tip aren't exact but close enough to mark.