Needle Visualization

The first key rule when performing the needle guided in-plane method is that the needle should not be advanced unless the complete needle is seen; otherwise, the process is inherently blind and there is no image guidance. As mentioned earlier, the process begins when the needle penetrates about 1 cm of the skin at the puncture site. At this time, place the transducer on the projected needle path and identify the echo needle. This is achieved by panning the transducer left and right on the needle. Since the sound beam is focused, it is not uncommon for the needle to be directly under the transducer but not visible on the ultrasound image. The left and right translation of the transducer can only be 1 mm at a time to avoid moving the transducer away from the needle. It is often helpful to look down at the surgical site to ensure that the needle is indeed below and parallel to the plane of the transducer. Once again, the needle should not be advanced until the needle is fully visible. Another basic concept is that the needle and transducer should not move at the same time. Move the transducer to recognize the needle, and then advance the needle. If the needle is no longer visible during the procedure, stop inserting the needle and move the transducer as before until the needle is visible again and is completely flat. When the needle advances again, the transducer is fixed in place.

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