Look Before You Stick!

Look before you stick

Narration

So ultrasound can be helpful in any procedure where you are trying to access fluid, but an important principle is that before you put a needle in something, you want to make sure there actually is a fluid collection that you can access. This is an example of a patient who was thought to have a joint effusion at the metacarpophalengeal joint of the hand-it was swollen and tender, but when you look with ultrasound, if you look carefully you can see

Arthrocentesis

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Narration

bones, the shadowing, and the joint space and there is really no fluid in this space, so it's going to be futile to try to put a needle in that.

Arthrocentesis

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Narration

This is contrasted to a knee effusion here where we see that needle going in and entering that fluid filled space. If you have a large joint effusion you may not need ultrasound to identify it, but in this case we can find the shortest distance between the skin and the fluid collection and here we are showing dynamic guidance of the needle into the space.

Cellulitis vs. Abscess

“Cobblestoning”

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Cellulitis vs. Abscess

Note air bubbles

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Other

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US Guided Procedures - Summary

Start with peripheral IV access
Understand in-plane vs. out-of-plane
Know where your needle tip is
Practice!!!

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Procedural Ultrasound

--- Table of Contents ---

Lesson Name	Minutes	id
Introduction	5	111
Basics	3	112
In and Out of Plane	4	113
Peripheral Vascular Access	4	114
IJ Access	2	115
Femoral Access	2	116
Subclavian Access & Confirmation	3	117
Other Procedures	3	118
Thoracentesis & Paracentesis	3	119
Cardiac Procedures	4	120
US Guided Nerve Block	1	121
Look Before You Stick!	4	122
Quiz Question #1	1	123
Quiz Question #2	1	124
Quiz Question #3	1	125