Favorite fluoro “pointer”

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camkiss

camkiss

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Physician
20+ Year Member
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.
 
camkiss said:
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.
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I had a collection of those Medtronics tunneling tools with the sharp tip unscrewed. Had them sterilized and used in office and hospital
 
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.
 
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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
 
SSdoc33 said:
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
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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
 
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.
 
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.
 
Also, I sometimes palpate PSIS or iliac crest quickly to get a better idea for my initial image.
 
@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.
 
callmeanesthesia said:
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.
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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.
 
dipriMAN said:
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.
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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 said:
18G stuck through the end of the plastic straw tube that the spinal needles or RF cannulas come in.
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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
 
oreosandsake said:
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
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Those blue OR towels are “gifts” for the patient after RF. I have some patience come for the RF just for the towels.
 
callmeanesthesia said:

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

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