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The desired vessel or cavity is punctured with a sharp hollow needle, with ultrasound guidance if necessary. A round-tipped guidewire is then advanced through the lumen of the needle, and the needle is withdrawn. A sheath or blunt cannula can now be passed over the guidewire into the cavity or vessel.
This procedure has fallen out of favor with the development of safer techniques for central venous catheterization such as the Seldinger technique, the modified Seldinger technique, [1] [2] [3] intraosseous infusion, as well as the use of ultrasound guidance for placement of central venous catheters without using the cutdown technique. [4] [5] [6]
Image guidance is therefore advocated to ensure safe and accurate needle placement. Fluoroscopic-guidance was the mainstay imaging-guidance hip injection, but ultrasound-guidance is becoming increasingly prevalent due to its accuracy with visualization of soft tissue and neurovascular structures, less associated cost and no ionizing radiation ...
The insertion site of the IJV is fixed between the two heads (sternal and clavicular heads) of the sternocleidomastoid. 2% lignocaine is to infiltrate the puncture site. Using a 24G needle attached to 5 cc syringe, the needle is advanced through the puncture site with its tip pointing towards the nipple of the same side.
Disadvantages of the supraclavicular block include the risk of pneumothorax, which is estimated to be between 1%–4% when using paresthesia or peripheral nerve stimulator guided techniques. Ultrasound guidance allows the operator to visualize the first rib and the pleura, thereby helping to ensure that the needle does not puncture the pleura ...
Within North America and Europe, ultrasound use now represents the gold standard for central venous access and skills, with diminishing use of landmark techniques. [32] [33] Recent evidence shows that ultrasound-guidance for subclavian vein catheterization leads to a reduction in adverse events. [34] [35] [36]
[93] [94] With ultrasound guided placement of a 25 gauge needle within the cyst, and after evacuation of the cyst fluid, about 50% of the cyst volume is injected back into the cavity, under strict operator visualization of the needle tip. The procedure is 80% successful in reducing the cyst to minute size.
Thoracentesis / ˌ θ ɔː r ə s ɪ n ˈ t iː s ɪ s /, also known as thoracocentesis (from Greek θώραξ (thōrax, GEN thōrakos) 'chest, thorax' and κέντησις (kentēsis) 'pricking, puncture'), pleural tap, needle thoracostomy, or needle decompression (often used term), is an invasive medical procedure to remove fluid or air from the pleural space for diagnostic or therapeutic ...