Ultrasound guidance

Transcoronary venous injection is performed with a catheter system threaded percutaneously into the coronary sinus. Initial studies in swine have confirmed the feasibility and safety of this approach [121]. This delivery method has also been used to deliver skeletal myoblasts to scarred myocardium in cardiomyopathy patients [120]. With intravascular ultrasound guidance, this approach allows the operator to extend a catheter and needle away from the pericardial space and coronary artery into the adjacent myocardium. To date, human feasibility studies have had a good safety profile. This technique is limited, however, by coronary venous tortuosity, lack of site specific targeting, and its own technically challenging nature. Unlike the transendocardial approach, in which cells are... 

Karrillon GJ, Morice MC, Benveniste E, et al. Intracoronary stent implantation without ultrasound guidance and with replacement of conventional anticoagulation by antiplatelet therapy. 30-day clinical outcome of the French Multicenter Registry. Circulation I 996 94 1 51 9-1 527. 

When 99% ethanol was instilled into renal cysts under ultrasound guidance in 25 cases, there were 12 complications after puncture, either related to the puncture itself or caused by the ethanol (17). They included flank pain. 

Furuta H, Nakada T, Akiya T, Ishikawa N, Satomi S, Sakamoto M, Kohno T, Kazama T, Umeda K, Sasagawa I, et al. [Renal cyst puncture under ultrasound guidance complications of ethanol injection.] Hinyokika Kiyo 1988 34(9) 1575-8. 

Inadvertent spinal anesthesia and subsequent nervous system toxicity, for example with transient paralysis or apnea, are the main complications of stellate ganglion block (SEDA-22, 140). It has been suggested that ultrasound guidance when performing the block might improve safety (357). The use of very small test doses and an anterior approach to the stellate ganglion are recommended preventive measures. 

Orford JL, Lerman A, Holmes DR. Rouhne intravascular ultrasound guidance of percutaneous coronary intervention A critical reappraisal. J Am Coll Cardiol 2004 43 1335-1342. 

Hydrogen ion concentration, blood gases and serum lactate concentration can be measured in fetal blood. Such measurements are only requested when non-inva-sive investigations have indicated that the fetus is at risk. Fetal blood can be obtained by the technique of cordoccntcsis, where the blood is sampled from the umbilical cord through a fine needle inserted through the abdomen under ultrasound guidance. 

The preferred reduction technique is either that of the air enema under fluoroscopic guidance or of air or hydrostatic enema under ultrasound guidance. The only absolute contra-indication to attempted enema reduction is full thickness bowel necrosis (which will present with features of shock and peritonitis) or if there is imaging evidence of perforation with free air. 

Fig. 7.9. An 8-year-old boy with a perirectal appendiceal abscess. The image shows the needle positioned, using ultrasound guidance, through the posterior rectal wall within the abscess (courtesy of Dr. L. Fontalva, Hospital for Sick Children, Toronto, Canada)...

Runyon B, Hoefs JC, Morgan TR (1988) Ascitic fluid analysis in malignancy related ascites. Hepatology 8 1104-1109 Sistrom CL, Abbitt PL, Feldman PS (1992) Ultrasound guidance for biopsy of omental abnormahties. J Clin Ultrasound 20 27-31... 

Ultrasound Med Biol 10 629-634 Smith EH (1991) Complications of percutaneous abdominal fine-needle biopsy. Radiology 178 253-258 Solbiati L, Montali G, Croce F et al (1986) Fine-needle aspiration biopsy of bowel lesions under ultrasound guidance indications and results. Gastrointest Radiol 11 172-176... 

Use of real-time ultrasound guidance during central line insertion to prevent complications ... 

Nilsson A, Krause J (2003) Targeted tumour biopsy under contrast-enhanced ultrasound guidance. Eur Radiol 13 Suppl 4 L239-240... 

Only pOz readings obtained under ultrasound guidance included... 

Ultrasound can be used to guide vascular access. Some authors have advocated routine use of ultrasound while a large retrospective study at one institution found no significant difference in complication rates between standard landmark approach and ultrasound guidance (16,17). 

Martin Ml, Husain FA, Piesman M, MuUenix PS, Steele SR, Andersen CA, Giacoppe GN. Is routine ultrasound guidance for central line placement beneficial A prospective analysis. CurrSurg 2004 61 71-74. 

When ultrasound guidance is used, a preliminary examination of the upper arm is performed to identify a suitable access vein. The basilic vein is the preferred site. The cephalic vein can be used,but is prone to spasm and has an acute angle as it joins the axillary vein. The veins are typically imaged in the transverse plane while the (echo-enhanced) needle is advanced (Fig. 6.4). The transducer is rocked cephalad and caudad keeping track of the needle tip. When this... 

Fig. 6.4. Transverse ultrasound image of a needle tip within a basilic vein during a peripherally inserted central catheter insertion under ultrasound guidance...

Initial access into either the IJV or the SCV is gained with standard ultrasound guidance using micropuncture techniques. The 0.018-in. mandril guidewire is placed into the right atrium (RA). The tract is dilated over the mandril wire and then the non-tapered catheter is advanced over the wire until the tip is in the superior aspect of the RA. In patients with excessive soft tissue thickness, it is often difficult to directly insert the soft silicone non-tapered catheter. In these cases, it will be necessary to use a peel-away sheath to insert the catheter into the venous system. The catheter is fiushed, heparinized, and secured with no absorbable 3-0-suture material (Mauro and Weeks 1998b). 

Clarke C, Moore J, Wedlake C, Lee D, Ganapathy S, Salbalbal M, Wikon T, Peters T, Bainbridge D. Virtual reality imaging with real-time ultrasound guidance for facet joint injection a proof of concept. Anesth Analg 2010 110(5) 1461-3. 

Pratt P, Di Marco A, Payne C, Darzi A, Yang G-Z. Intraoperative ultrasound guidance for transanal endoscopic microsurgery. Med Image Comput Comput Assist Interv 2012 7510 463-70. 

---