Get A Grip

     One of the most common errors I see people commit as they begin using ultrasound is [nonmember]…

 

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in the way they hold the probe. Many people hold the probe away from the base and keep their hand off of the patient entirely. It is well known that the most difficult aspect of utilizing ultrasound is maintaining ‘needle-beam alignment’, and most people have this trouble because of their probe hand (and needle hand) positioning.

     Holding the probe incorrectly as I described above leads to ‘gross motor’ (instead of ‘fine motor’) adjustments and movements of the probe which will tend to be too large. Also, it is virtually impossible to keep the probe from moving especially since you are applying pressure on a surface covered with ultrasound gel.

     Before your probe touches the patient, the base of your hand should be firmly (but not painfully, of course) applied to the patient’s body for stabilization. Your proprioceptive sense of direction will be significantly improved by this change, and this will help in maintaining a ‘stable picture’ while you advance your needle. Now as fine adjustments of the probe need to be made, you will be able to do so successfully with your fingers. Doing so with the incorrect grip, you will tend to utilize your wrist, elbow or shoulder which makes minor adjustments very difficult. Further, with a proper grip, once the optimized view is identified, it should not move even if you need to turn to pick up your skin infiltration needle or other equipment.

     Hold the probe so that the side under which your needle will first come into view is held by your thumb as well as your index finger. This should put the other end of the probe up against your adductor pollicis muscle at the base of your thumb and index finger. This will also aid your proprioception as you are looking away at the screen. Some people hold the probe with the index finger at on end and the thumb at the other end. This is suboptimal for proprioceptive sense as well as for fine probe adjustments.

     Lastly, apply the ‘firm base’ strategy and use of your fingers for fine adjustments to your needling hand as well. Aim your needle into the ‘pocket’ (formed at the base of your index finger and thumb) by your probe hand instead of toward an index finger with the improper grip.

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