Ultrasound needles

[BobBarker]

I purchased a vscan air. First patient was for tibial nerve blocks. I could see my anatomy fine. I used a 20g Tuohy but could not see it at all. Got the blocks in using hydrodissection. Looking for recs for cheap but better needles.

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[Ligament]

Pajunk sonographic needles are the best, but very very expensive
Clint Pharmaceuticals carries a brand of sonographic needles made in Japan I believe which are cheaper and good. Good enough that I rarely need the Pajunk needles.

 

[Orin]

I purchased a vscan air. First patient was for tibial nerve blocks. I could see my anatomy fine. I used a 20g Tuohy but could not see it at all. Got the blocks in using hydrodissection. Looking for recs for cheap but better needles.

Do you have a phantom to check this out in? A 20g Tuohy is very hyperechoic so I would want to rule out something weird with the signal processing on the handheld unit. There's a surprising amount of processing that goes into making a nice US image. Looking on the GE Website, I oddly enough don't see any clinical pictures with needles in view although their pics look nice.

 

[BobBarker]

Good point. I had it in nerve mode also. So maybe vasc or msk presets would be better. I haven’t done any us in years but I still think I should have seen the needle. I gave myself a knee injection with it also and could not see the 25g needle. But my knee got numb.

 

[Orin]

Good point. I had it in nerve mode also. So maybe vasc or msk presets would be better. I haven’t done any us in years but I still think I should have seen the needle. I gave myself a knee injection with it also and could not see the 25g needle. But my knee got numb.

That's weird. It should do fine but I would really play with it before you invest in a fancy needle. It might just have a very narrow slice where it captures as compared to a traditional probe.

 

[callmeanesthesia]

I’ve never gotten to play with the hyperechoic needles but I agree with Orin - you should be able to see a 20g pretty easily. There may be something with the settings that’s smoothing it out.

 

[epidural man]

I have used all kinds of echogenic needles. Nothing beats the 20g Tuohy - a real one with a stylet. Lots of people make a "touhy" needle for blocks that don't have the stylet. That makes a big difference. I suspect the hollow channel in the middle makes the needle more echogenic - thus the reason a thinner wall, large hole, another thin wall - is better than just a shape of the tip.

 

[SeniorWrangler]

Nothing beats those Pajunk 100s… like doing the injection with a lightsaber bzzoww!

 

[oreosandsake]

Hate to be the one to say it but maybe practice a little if it’s been a while since you’ve used much US. The beam is less than 1 mm thick typically. 25g needle is o.5 mm if I remember correctly. 20g is pretty hefty

 

[deleted875186]

Should always be able to see a 20G. Practice and take extra time in the next few to brush up.

I second the 22G 10cm Pajunk, king of all ultrasound needles.

 

[Laryngospasm]

I’ve always used the medline ultrasound 21g blunt tip. Seems to work well.

 

[Ligament]

You should only need sonographic needles for deep structures requiring acute angles of entry. Otherwise they are a poor ROI. If your needle is at all perpendicular to the beam it should be quite visible.

 

[BobBarker]

I agree I need to practice. Pork shoulder on my shopping list.

 

[Sooshi]

I've been a big fan of BBraun's stimuplex needles - crisp as all get-out. After playing with them in residency it was very disappointing and difficult to go back to the old-fashioned pointy things.