US regional with no assistant

[caligas]

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anybody doing their own injecting? Seems like aspiration to check for intravasculsr would be awkward. Any thoughts?

 

[risnwb]

I've considered using one of those syringes with a thumb hook on it like the dentists use, but haven't tried it. Seems like it would work ok but I'd rather not have to put down ultrasound probe while switching out syringe..

 

[caligas]

Good idea, but to me adding any special equipment would defeat the purpose.

 

[Shouldawouldacouldas]

I always have an assistant. I use anyone who is available.

 

[dhb]

Never had an assistant, never aspirate either. I hold the needle and the syringe in one hand and let go of the needle to inject

 

[nimbus]

Never had an assistant, never aspirate either. I hold the needle and the syringe in one hand and let go of the needle to inject

Same as DHB....but I still need an assistant to hit the save/print image button.

 

[Mman]

there is no nurse around? Seems a bit odd. The patient needs to be monitored and if there was anything happening you'd need somebody else to help resuscitate the patient and/or go get help/intralipid/code cart/whatever. I can't imagine any reasonable guideline would support doing a procedure on a patient with nobody else in the room/bedspace.

Don't you do a timeout with somebody?

 

[risnwb]

Never had an assistant, never aspirate either. I hold the needle and the syringe in one hand and let go of the needle to inject

I'm all confident and stuff about where my needle tip is but honestly, I can't imagine not aspirating at least
Once before injecting... It takes less than a second... Worst complication from a block is cardiopulmonary bypass after iv injection...

 

[fakin' the funk]

There are three strategies.

1) Never use an assistant.

I favor this because your assistants' skills and dexterity are very variable, and the equipment available is very variable (e.g., one place I work NEVER has those microbore tubings you would use to connect assistant's syringe to your block needle). Variability is something I don't need when I'm injecting what could be a fatal intravascular dose of LA.

For all the single-shots I do, I personally am doing the U/S with left hand and injecting with right hand. Always a 30ml syringe on a 18g Tuohy, and usually since these are blocks for postop analgesia, 0.25% bupi w/ epi. I am good at seeing the entire needle and since I use the same size syringe every time, I know the expected resistance. Since I am seeing the needle, if there is ANY question that the 2-3ml I just gave isn't showing up on the screen in the expected amount, I aspirate, by using my right thumb to pull back on the plunger or by slightly "choking up" on the syringe and using fingers 3-5 to pull back on the plunger. The hand position while injecting is supinated with fingers together like "Italian saying mamma mia" and while aspirating is fully pronated "drawing the sword from the stone."

2) Always use an assistant.

A reasonable option, as long as you recognize that you are adding a) time and b) variability to your procedure.

3) Sometimes use an assistant.

Great, now your variability has variability.

 

[kazuma]

No assistant either unless someone is available to hit print. I like to feel the injection myself and I don't like to waste time finding an assistant. I use similar techniques as described here and I always aspirate every 3-5ml.


However, I almost always have an assistant for neuraxial especially when the pt is sitting.

 

[Mman]

2) Always use an assistant.

A reasonable option, as long as you recognize that you are adding a) time and b) variability to your procedure.

In what way does an assistant add time to your procedure? Unless they are terrible, they will make it go faster.

 

[Sonny Crocket]

There are three strategies.

1) Never use an assistant.

I favor this because your assistants' skills and dexterity are very variable, and the equipment available is very variable (e.g., one place I work NEVER has those microbore tubings you would use to connect assistant's syringe to your block needle). Variability is something I don't need when I'm injecting what could be a fatal intravascular dose of LA.

For all the single-shots I do, I personally am doing the U/S with left hand and injecting with right hand. Always a 30ml syringe on a 18g Tuohy, and usually since these are blocks for postop analgesia, 0.25% bupi w/ epi. I am good at seeing the entire needle and since I use the same size syringe every time, I know the expected resistance. Since I am seeing the needle, if there is ANY question that the 2-3ml I just gave isn't showing up on the screen in the expected amount, I aspirate, by using my right thumb to pull back on the plunger or by slightly "choking up" on the syringe and using fingers 3-5 to pull back on the plunger. The hand position while injecting is supinated with fingers together like "Italian saying mamma mia" and while aspirating is fully pronated "drawing the sword from the stone."

2) Always use an assistant.

A reasonable option, as long as you recognize that you are adding a) time and b) variability to your procedure.

3) Sometimes use an assistant.

Great, now your variability has variability.

You use a Tuohy for your blocks?

 

[fakin' the funk]

You use a Tuohy for your blocks?

Yep. Was trained almost exclusively with them. Big so easy to see, blunt so difficult to spear a trunk/cord/nerve, easy to pass a catheter through. Can even use the "back" side (the side opposite the aperture) to put traction on nerves/vessels, though I'm not a huge fan of doing so.

For ultrasound "intermediate" cervical plexus blocks I'm using a 2" B bevel block needle, but otherwise, Tuohys.

 

[Velefunt]

My practice locations require an assistant as policy, as the RN has her own set of documentation and "timeout" that must be performed.

 

[DrLight]

Here is what some anesthesiologists from across the pond are doing....
Video tutorial from LSORA showcasing three potential techniques that allow the regional anaesthetist to simultaneously handle the needle and inject the local anaesthetic

 

[deleted162650]

I always have an assistant but I may have to give the "Allan" grip a try. Not so fond of the other two.

 

[dhb]

I'm all confident and stuff about where my needle tip is but honestly, I can't imagine not aspirating at least
Once before injecting... It takes less than a second... Worst complication from a block is cardiopulmonary bypass after iv injection...

I don't inject lethal doses, that's what assitants do

 

[Velefunt]

Here is what some anesthesiologists from across the pond are doing....
Video tutorial from LSORA showcasing three potential techniques that allow the regional anaesthetist to simultaneously handle the needle and inject the local anaesthetic

Helpful link - thanks; I think I might give the Allan grip a try as well.