Another Way of Locating the Needle Tip in Ultrasound-guided Deep Vein Cannulation

Some people say that an acoustic shadow of a needle is a nuisance during ultrasound-guided vessel puncture. Indeed, this may be true for longitudinal imaging. However, an acoustic shadow can aid puncture under transverse imaging, as shown in this video. I named the technique "acoustic shadow tracing method" (AS tracing). Importantly, even when mainly using a technique other than AS tracing under transverse imaging, the quality of puncture can be improved by paying attention to the acoustic shadow. For that purpose, it is necessary to have knowledge of the device selection and ultrasound setting that clearly depicts acoustic shadows.
A nephrologist in Kyoto, Tadashi Kamata, MD
********** Contents of this video **************
Click on the blue type below to jump to a specific stage of the video.
00:00 Start
1. 00:10 Background
2. 01:12 Principle of AS tracing
3. 01:58 Ultrasound setting
4. 03:08 Determination of puncture site
5. 03:37 Simulation
6-1. 05:27 Case 1
6-2. 09:15 Case 2
7. 13:19 Take-home message
************** Devices used in the video **************
●Hemodialysis cannula: Happycath N (Medikit, Japan)
●Midline catheter: PI catheter (Covidien, Japan) An introducer needle for CV catheter (the length of its sheath is 53mm) was substituted for the introducer needle attached to the kit, because the target upper arm basilic vein was deep (1.5cm).
●Ultrasound device: iLook, NanoMaxx (Sonosite)
************** Relevant papers & videos **************
Kamata T, et al. Ultrasound-guided cannulation of hemodialysis access. Ren Replace Ther 2016; 2:7 doi.org/10.1186/s41100-016-00...
(My review article on ultrasound guided cannulation)
Kamata T, et al. Blood purification therapy using repeated ultrasound-guided femoral vein puncture: Report of sixteen cases. J Jpn Soc Dial Ther. 2012;45:241-6 (in Japanese).
www.jstage.jst.go.jp/article/...
(16 cases to which the acoustic shadow tracing method was applied)
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鎌田ほか. 末梢静脈確保困難のためミッドラインカテーテルを超音波ガイド下に留置した肥満合併切迫早産の1例（Midline catheter use in an obesity case of difficult peripheral venous access with threatened premature delivery). 静脈経腸栄養 2014; 29: 91-4.
www.jstage.jst.go.jp/article/...
Ultrasound guided peripheral venous cannulation in an actual patient
• Ultrasound guided peri...

[@No-xh2cs]

Thank you I will try this next time I have difficulty finding the tip in deep tissue