Thumb–Index Guide Manoeuvre to Potentially Keep Needle In-plane during Interventional Ultrasound

It has been observed that ultrasonographic needle insertion, whether in-plane or out-of-plane, could be facilitated by needle guidance devices/manoeuvres.[1-3] However, needle guidance devices may sometimes be inaccessible,[4] while proceduralists may sometimes be inexperienced in needle guidance manoeuvres. Therefore, to ergonomically guide the needle in-plane, herein described simple technique may prove useful to maintain a continuous visualisation of the in-plane needle. As simulated in Figure 1 with a hockey stick-shaped linear array probe [Figure 1a] and standard-shaped linear array probe [Figure 1b], the proceduralist’s thumb–index finger [as indicated by red arrows in Figure 1] can guide and keep the needle in-plane so that the needle moving in-plane remains continuously visible. As Figure 1a and b comparatively depicts the two probes, it seems apparent that the hockey stick-shaped linear array probe with its smaller footprint in the proceduralist’s hand can be advantageous for this thumb–index guide manoeuvre as compared to standard-shaped linear array probe with its larger footprint in the proceduralist’s hand. While exercising additional caution with regard to needle-stick injury, it may concurrently be ideal to use sterile gloves for this thumb–index guide manoeuvre in case the moving needle inadvertently contacts the gloved thumb–index finger. Moreover, during in-plane ultrasound imaging for vascular access,[5-7] it may be better to choose a site of insertion where the vein and the artery have sufficient lateral separation to reduce the risk for inadvertent arterial puncture during the intended venipuncture. In a nutshell, simple adjustment by proceduralist in holding the ultrasound probe with the thumb–index finger projecting further beyond the ultrasound probe may guide and manoeuvre the needle insertion during the in-plane ultrasonography for interventional procedures.Figure 1: (a and b) Simulated thumb–index guide manoeuvre with red arrows highlighting thumb–index finger holding hockey stick-shaped linear array probe, (a) and standard-shaped linear array probe (b)Authors’ contributions DG: Contributed to concept, simulation, manuscript preparation, manuscript editing and manuscript review, DB: Contributed to simulation, manuscript editing and manuscript review. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.