How To Perform An Ultrasound-Guided Hip Injection
How To Perform An Ultrasound-Guided Hip Injection
/sites/default/files/Coach_pollock_hip_injection_thumb.jpg
Dr. Scott Pollock demonstrates how to perform an ultrasound guided hip injection.
Clinical Specialties
Media Library Type
Media Library Tag
Subtitles
<p begin="00:00:09.894" end="00:00:13.434" style="s2">- I'm gonna do a simulated<br />hip injection now,</p>
<p begin="00:00:13.434" end="00:00:16.769" style="s2">and show you how this is approached.</p>
<p begin="00:00:16.769" end="00:00:18.377" style="s2">I'm not using a sterile technique,</p>
<p begin="00:00:18.377" end="00:00:21.007" style="s2">and I'm not actually going<br />to insert the needle,</p>
<p begin="00:00:21.007" end="00:00:23.802" style="s2">but I will show you how it's approached.</p>
<p begin="00:00:23.802" end="00:00:26.871" style="s2">The needle that I've selected is</p>
<p begin="00:00:26.871" end="00:00:29.712" style="s2">an echo block needle, is what it's called.</p>
<p begin="00:00:29.712" end="00:00:31.564" style="s2">This is a hundred millimeter,</p>
<p begin="00:00:31.564" end="00:00:33.387" style="s2">approximately four inch needle.</p>
<p begin="00:00:33.387" end="00:00:35.178" style="s2">You can also use a spinal needle,</p>
<p begin="00:00:35.178" end="00:00:38.283" style="s2">but in an individual who is large,</p>
<p begin="00:00:38.283" end="00:00:42.641" style="s2">sometimes you need a<br />special needle like this,</p>
<p begin="00:00:42.641" end="00:00:46.808" style="s2">which has marks on it that<br />reflect the ultrasound beam</p>
<p begin="00:00:48.606" end="00:00:50.730" style="s2">and make it much more visible.</p>
<p begin="00:00:50.730" end="00:00:52.079" style="s2">The orientation will be the same</p>
<p begin="00:00:52.079" end="00:00:54.384" style="s2">as demonstrated previously.</p>
<p begin="00:00:54.384" end="00:00:58.096" style="s2">The image on the screen the<br />same as we've seen before,</p>
<p begin="00:00:58.096" end="00:01:02.447" style="s2">with the femoral neck<br />being the target area.</p>
<p begin="00:01:02.447" end="00:01:06.530" style="s2">And what I would do is<br />mark with an indelible pen</p>
<p begin="00:01:07.788" end="00:01:09.828" style="s2">close to the transducer,</p>
<p begin="00:01:09.828" end="00:01:12.624" style="s2">cleanse this area, anesthetize it,</p>
<p begin="00:01:12.624" end="00:01:16.791" style="s2">and insert the needle at<br />approximately this angle.</p>
<p begin="00:01:18.042" end="00:01:20.165" style="s2">Parallel to the transducer,</p>
<p begin="00:01:20.165" end="00:01:24.248" style="s2">so that the needle is<br />as visible as possible.</p>
<p begin="00:01:24.248" end="00:01:27.582" style="s2">You can check the angle of<br />the needle quite quickly</p>
<p begin="00:01:27.582" end="00:01:31.257" style="s2">once you see the needle<br />coming in on the right top</p>
<p begin="00:01:31.257" end="00:01:35.424" style="s2">of the screen, and adjust<br />the angle depth accordingly.</p>
<p begin="00:01:37.147" end="00:01:41.296" style="s2">The goal is to bring the tip of the needle</p>
<p begin="00:01:41.296" end="00:01:43.213" style="s2">into the V of the neck,</p>
<p begin="00:01:45.657" end="00:01:47.907" style="s2">and that will be the joint.</p>
<p begin="00:01:51.810" end="00:01:54.705" style="s2">This injection could be performed</p>
<p begin="00:01:54.705" end="00:01:58.161" style="s2">with a transducer in the<br />longitudinal position,</p>
<p begin="00:01:58.161" end="00:02:02.426" style="s2">coming in this way, or<br />could be done transversely,</p>
<p begin="00:02:02.426" end="00:02:04.548" style="s2">with the transducer in this position,</p>
<p begin="00:02:04.548" end="00:02:07.785" style="s2">but I'm using an in-plane approach.</p>
<p begin="00:02:07.785" end="00:02:11.558" style="s2">The needle and the syringe<br />are parallel to the direction</p>
<p begin="00:02:11.558" end="00:02:13.058" style="s2">of the transducer.</p>
<p begin="00:02:14.127" end="00:02:18.478" style="s2">I would then insert the needle<br />approximately a centimeter</p>
<p begin="00:02:18.478" end="00:02:20.979" style="s2">away from the transducer.</p>
<p begin="00:02:20.979" end="00:02:25.267" style="s2">The closer you get, the more<br />steep the angle has to be</p>
<p begin="00:02:25.267" end="00:02:27.479" style="s2">to get down to this depth,</p>
<p begin="00:02:27.479" end="00:02:31.140" style="s2">and so sometimes it's better<br />to be a little distance away</p>
<p begin="00:02:31.140" end="00:02:33.452" style="s2">from the edge of the transducer.</p>
<p begin="00:02:33.452" end="00:02:36.749" style="s2">By looking at the screen<br />you can see that the depth</p>
<p begin="00:02:36.749" end="00:02:40.946" style="s2">of the marker is nearly four centimeters,</p>
<p begin="00:02:40.946" end="00:02:43.818" style="s2">and the surface where the tendons are</p>
<p begin="00:02:43.818" end="00:02:45.312" style="s2">and the bursa,</p>
<p begin="00:02:45.312" end="00:02:49.479" style="s2">is down about two and a<br />half to three centimeters.</p>
<p begin="00:02:50.321" end="00:02:53.913" style="s2">So I'm gonna have to get<br />an angle that gets this</p>
<p begin="00:02:53.913" end="00:02:56.233" style="s2">down to the depths,</p>
<p begin="00:02:56.233" end="00:02:58.976" style="s2">and it's probably gonna<br />be something like this.</p>
<p begin="00:02:58.976" end="00:03:03.477" style="s2">The angle will be changed<br />by me as I enter the skin</p>
<p begin="00:03:03.477" end="00:03:05.667" style="s2">to direct the tip into the structure</p>
<p begin="00:03:05.667" end="00:03:07.334" style="s2">that I'm aiming for.</p>
<p begin="00:03:08.380" end="00:03:10.337" style="s2">This can also be injected</p>
<p begin="00:03:10.337" end="00:03:13.004" style="s2">in a transverse plane, this way,</p>
<p begin="00:03:14.200" end="00:03:17.468" style="s2">sometimes it's easier to<br />have the alignment going</p>
<p begin="00:03:17.468" end="00:03:20.028" style="s2">in the same direction as you're looking,</p>
<p begin="00:03:20.028" end="00:03:23.786" style="s2">so I'm looking across the<br />patient at the ultrasound screen,</p>
<p begin="00:03:23.786" end="00:03:27.953" style="s2">and I now have my transducer<br />pointing in that direction.</p>
<p begin="00:00:13.434" end="00:00:16.769" style="s2">and show you how this is approached.</p>
<p begin="00:00:16.769" end="00:00:18.377" style="s2">I'm not using a sterile technique,</p>
<p begin="00:00:18.377" end="00:00:21.007" style="s2">and I'm not actually going<br />to insert the needle,</p>
<p begin="00:00:21.007" end="00:00:23.802" style="s2">but I will show you how it's approached.</p>
<p begin="00:00:23.802" end="00:00:26.871" style="s2">The needle that I've selected is</p>
<p begin="00:00:26.871" end="00:00:29.712" style="s2">an echo block needle, is what it's called.</p>
<p begin="00:00:29.712" end="00:00:31.564" style="s2">This is a hundred millimeter,</p>
<p begin="00:00:31.564" end="00:00:33.387" style="s2">approximately four inch needle.</p>
<p begin="00:00:33.387" end="00:00:35.178" style="s2">You can also use a spinal needle,</p>
<p begin="00:00:35.178" end="00:00:38.283" style="s2">but in an individual who is large,</p>
<p begin="00:00:38.283" end="00:00:42.641" style="s2">sometimes you need a<br />special needle like this,</p>
<p begin="00:00:42.641" end="00:00:46.808" style="s2">which has marks on it that<br />reflect the ultrasound beam</p>
<p begin="00:00:48.606" end="00:00:50.730" style="s2">and make it much more visible.</p>
<p begin="00:00:50.730" end="00:00:52.079" style="s2">The orientation will be the same</p>
<p begin="00:00:52.079" end="00:00:54.384" style="s2">as demonstrated previously.</p>
<p begin="00:00:54.384" end="00:00:58.096" style="s2">The image on the screen the<br />same as we've seen before,</p>
<p begin="00:00:58.096" end="00:01:02.447" style="s2">with the femoral neck<br />being the target area.</p>
<p begin="00:01:02.447" end="00:01:06.530" style="s2">And what I would do is<br />mark with an indelible pen</p>
<p begin="00:01:07.788" end="00:01:09.828" style="s2">close to the transducer,</p>
<p begin="00:01:09.828" end="00:01:12.624" style="s2">cleanse this area, anesthetize it,</p>
<p begin="00:01:12.624" end="00:01:16.791" style="s2">and insert the needle at<br />approximately this angle.</p>
<p begin="00:01:18.042" end="00:01:20.165" style="s2">Parallel to the transducer,</p>
<p begin="00:01:20.165" end="00:01:24.248" style="s2">so that the needle is<br />as visible as possible.</p>
<p begin="00:01:24.248" end="00:01:27.582" style="s2">You can check the angle of<br />the needle quite quickly</p>
<p begin="00:01:27.582" end="00:01:31.257" style="s2">once you see the needle<br />coming in on the right top</p>
<p begin="00:01:31.257" end="00:01:35.424" style="s2">of the screen, and adjust<br />the angle depth accordingly.</p>
<p begin="00:01:37.147" end="00:01:41.296" style="s2">The goal is to bring the tip of the needle</p>
<p begin="00:01:41.296" end="00:01:43.213" style="s2">into the V of the neck,</p>
<p begin="00:01:45.657" end="00:01:47.907" style="s2">and that will be the joint.</p>
<p begin="00:01:51.810" end="00:01:54.705" style="s2">This injection could be performed</p>
<p begin="00:01:54.705" end="00:01:58.161" style="s2">with a transducer in the<br />longitudinal position,</p>
<p begin="00:01:58.161" end="00:02:02.426" style="s2">coming in this way, or<br />could be done transversely,</p>
<p begin="00:02:02.426" end="00:02:04.548" style="s2">with the transducer in this position,</p>
<p begin="00:02:04.548" end="00:02:07.785" style="s2">but I'm using an in-plane approach.</p>
<p begin="00:02:07.785" end="00:02:11.558" style="s2">The needle and the syringe<br />are parallel to the direction</p>
<p begin="00:02:11.558" end="00:02:13.058" style="s2">of the transducer.</p>
<p begin="00:02:14.127" end="00:02:18.478" style="s2">I would then insert the needle<br />approximately a centimeter</p>
<p begin="00:02:18.478" end="00:02:20.979" style="s2">away from the transducer.</p>
<p begin="00:02:20.979" end="00:02:25.267" style="s2">The closer you get, the more<br />steep the angle has to be</p>
<p begin="00:02:25.267" end="00:02:27.479" style="s2">to get down to this depth,</p>
<p begin="00:02:27.479" end="00:02:31.140" style="s2">and so sometimes it's better<br />to be a little distance away</p>
<p begin="00:02:31.140" end="00:02:33.452" style="s2">from the edge of the transducer.</p>
<p begin="00:02:33.452" end="00:02:36.749" style="s2">By looking at the screen<br />you can see that the depth</p>
<p begin="00:02:36.749" end="00:02:40.946" style="s2">of the marker is nearly four centimeters,</p>
<p begin="00:02:40.946" end="00:02:43.818" style="s2">and the surface where the tendons are</p>
<p begin="00:02:43.818" end="00:02:45.312" style="s2">and the bursa,</p>
<p begin="00:02:45.312" end="00:02:49.479" style="s2">is down about two and a<br />half to three centimeters.</p>
<p begin="00:02:50.321" end="00:02:53.913" style="s2">So I'm gonna have to get<br />an angle that gets this</p>
<p begin="00:02:53.913" end="00:02:56.233" style="s2">down to the depths,</p>
<p begin="00:02:56.233" end="00:02:58.976" style="s2">and it's probably gonna<br />be something like this.</p>
<p begin="00:02:58.976" end="00:03:03.477" style="s2">The angle will be changed<br />by me as I enter the skin</p>
<p begin="00:03:03.477" end="00:03:05.667" style="s2">to direct the tip into the structure</p>
<p begin="00:03:05.667" end="00:03:07.334" style="s2">that I'm aiming for.</p>
<p begin="00:03:08.380" end="00:03:10.337" style="s2">This can also be injected</p>
<p begin="00:03:10.337" end="00:03:13.004" style="s2">in a transverse plane, this way,</p>
<p begin="00:03:14.200" end="00:03:17.468" style="s2">sometimes it's easier to<br />have the alignment going</p>
<p begin="00:03:17.468" end="00:03:20.028" style="s2">in the same direction as you're looking,</p>
<p begin="00:03:20.028" end="00:03:23.786" style="s2">so I'm looking across the<br />patient at the ultrasound screen,</p>
<p begin="00:03:23.786" end="00:03:27.953" style="s2">and I now have my transducer<br />pointing in that direction.</p>
Brightcove ID
5734024006001
https://youtube.com/watch?v=9CxPnc2-sH4
Body
Dr. Scott Pollock demonstrates how to perform an ultrasound guided hip injection.