When placing IJ catheters, does use of ultrasound guidance decrease placement-related complications compared with using anatomical landmarks?

2022 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Lucas Labine ◽  
Alan Gill
Keyword(s):  
Ultrasound Guidance ◽  
Anatomical Landmarks

Transcricothyroid injection of local anaesthesia: a serious complication

2021 ◽  
Vol 14 (8) ◽  
pp. e244493
Author(s):  
Anna Li ◽  
Jason D'Costa
Keyword(s):  
Local Anaesthetic ◽  
Local Anaesthesia ◽  
Ultrasound Guidance ◽  
Rare Complication ◽  
Anatomical Landmarks ◽  
Topical Anaesthesia ◽  
Airway Compromise ◽  
Puncture Site ◽  
Clinician Satisfaction ◽  
The Right

Transcricothyroid membrane (CTM) injection of local anaesthesia is widely used during bronchoscopic procedures. It is an effective way of delivering topical anaesthesia, and has been shown to reduce patient discomfort, improve clinician satisfaction and reduce overall sedation requirements. Risks from this procedure are uncommon and usually minor. Localisation of the CTM is usually performed clinically by palpation of anatomical landmarks and can vary depending on clinician skillset and experience. Clinical identification may be less accurate compared with ultrasound guidance in identifying puncture site, however, ultrasound is not always readily available and seldom used for this purpose. This case describes a rare complication following attempted local anaesthetic infiltration into the cricothyroid space, after clinical identification of puncture site. An obstructive fluid-filled mass formed around the site of injection on the right vocal cord; resulting in airway compromise, abandonment of procedure and subsequent intubation.

Accuracy of talonavicular injection using ultrasound versus anatomical landmark: a cadaver study

2020 ◽  
Vol 61 (10) ◽  
pp. 1359-1364
Author(s):  
Aaradhana J Jha ◽  
Gean C Viner ◽  
Haley McKissack ◽  
Matthew Anderson ◽  
John Prather ◽  
...  
Keyword(s):  
Ultrasound Guidance ◽  
Joint Space ◽  
Anatomical Landmark ◽  
Neutral Position ◽  
Anatomical Landmarks ◽  
Talonavicular Joint ◽  
Ultrasound Guided ◽  
Needle Size ◽  
Complex Anatomy ◽  
Landmark Technique

Background Intra-articular injections have diagnostic and therapeutic roles in foot and ankle pathologies due to complex anatomy, small size, diverse bones, and joints with proximity in this region. Conventionally, these injections are carried out using anatomical landmark technique and/or fluoroscopic guidance. The small joint space and needle size make the injection challenging. Fluoroscopy is not readily available in the clinical setting; ultrasound-guidance for injections is therefore increasingly being used. We compared the accuracy of intra-articular talonavicular injections using the anatomical landmark technique versus the ultrasound-guided method. Purpose To determine whether ultrasound guidance yields superior results in intra-articular injections of the talonavicular joint compared to injections using palpatory method guided by anatomical landmarks. Material and Methods The feet of 10 cadaveric specimens were held in neutral position by an assistant while a fellowship-trained foot-ankle orthopedic surgeon injected 2 cc of radiopaque dye using anatomical landmarks and palpation method in five specimens and under ultrasound guidance in the remaining five. The needles were left in situ in all specimens and their placement was confirmed fluoroscopically. Results In all five specimens injected under ultrasound guidance, the needle was found to be in the joint, whereas all five injected by palpation only were out of the joint, with one in the naviculo-cuneiform joint, showing ultrasound guidance to significantly increase the accuracy of intra-articular injections in the talonavicular joint than palpatory method alone. Conclusion Ultrasound-guided injections not only confirm correct needle placement, but also delineate any tendon and/or joint pathology simultaneously.

scholarly journals Application of ultrasound guidance in the oral and maxillofacial nerve block

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12543
Author(s):  
Zhiwei Cao ◽  
Kun Zhang ◽  
Liru Hu ◽  
Jian Pan
Keyword(s):  
Nerve Block ◽  
Anterior Approach ◽  
Ultrasound Guidance ◽  
Anatomical Landmarks ◽  
Nerve Blocks ◽  
Anatomical Structures ◽  
Maxillary Nerve ◽  
Current Article ◽  
Nerve Localization ◽  
Oral And Maxillofacial Regions

Introduction Nerve block technology is widely used in clinical practice for pain management. Conventional nerve localization methods, which only rely on palpation to identify anatomical landmarks, require experienced surgeons and can be risky. Visualization technologies like ultrasound guidance can help prevent complications by helping surgeons locate anatomical structures in the surgical area and by guiding the operation using different kinds of images. There are several important and complex anatomical structures in the oral and maxillofacial regions. The current article reviews the application of ultrasound guidance in oral and maxillofacial nerve blocks. Methods We searched the literature on the use of ultrasound guidance for the main nerve block techniques in the oral and maxillofacial regions using both PubMed and MEDLINE and summarized the findings. Results and Discussion A review of the literature showed that ultrasound guidance improves the safety and effectiveness of several kinds of puncture procedures, including nerve blocks. There are two approaches to blocking the mandibular nerve: intraoral and extraoral. This review found that the role of ultrasound guidance is more important in the extraoral approach. There are also two approaches to the blocking of the maxillary nerve and the trigeminal ganglion under ultrasound guidance: the superazygomatic approach and the infrazygomatic approach. The infrazygomatic approach can be further divided into the anterior approach and the posterior approach. It is generally believed that the anterior approach is safer and more effective. This review found that the effectiveness and safety of most oral and maxillofacial nerve block operations can be improved through the use of ultrasound guidance.

Ultrasound Improves Cricothyrotomy Success in Cadavers with Poorly Defined Neck Anatomy

2015 ◽  
Vol 123 (5) ◽  
pp. 1033-1041 ◽  
Author(s):  
Naveed Siddiqui ◽  
Cristian Arzola ◽  
Zeev Friedman ◽  
Laarni Guerina ◽  
Kong Eric You-Ten
Keyword(s):  
Ultrasound Guidance ◽  
Airway Device ◽  
Insertion Time ◽  
Anatomical Landmarks ◽  
Cricothyroid Membrane ◽  
Digital Palpation ◽  
Device Placement ◽  
Human Cadavers ◽  
Neck Anatomy ◽  
The Mean

Abstract Background Misidentification of the cricothyroid membrane in a “cannot intubate-cannot oxygenate” situation can lead to failures and serious complications. The authors hypothesized that preprocedure ultrasound-guided identification of the cricothyroid membrane would reduce complications associated with cricothyrotomy. Methods A group of 47 trainees were randomized to digital palpation (n = 23) and ultrasound (n = 24) groups. Cricothyrotomy was performed on human cadavers by using the Portex® device (Smiths Medical, USA). Anatomical landmarks of cadavers were graded as follows: grade 1—easy = visual landmarks; 2—moderate = requires light palpation of landmarks; 3—difficult = requires deep palpation of landmarks; and 4—impossible = landmarks not palpable. Primary outcome was the complication rate as measured by the severity of injuries. Secondary outcomes were correct device placement, failure to cannulate, and insertion time. Results Ultrasound guidance significantly decreased the incidence of injuries to the larynx and trachea (digital palpation: 17 of 23 = 74% vs. ultrasound: 6 of 24 = 25%; relative risk, 2.88; 95% CI, 1.39 to 5.94; P = 0.001) and increased the probability of correct insertion by 5.6 times (P = 0.043) in cadavers with difficult and impossible landmark palpation (digital palpation 8.3% vs. ultrasound 46.7%). Injuries were found in 100% of the grades 3 to 4 (difficult–impossible landmark palpation) cadavers by digital palpation compared with only 33% by ultrasound (P < 0.001). The mean (SD) insertion time was significantly longer with ultrasound than with digital palpation (196.1 s [60.6 s] vs. 110.5 s [46.9 s]; P < 0.001). Conclusion Preprocedure ultrasound guidance in cadavers with poorly defined neck anatomy significantly reduces complications and improves correct insertion of the airway device in the cricothyroid membrane.

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