My Routine - Broome Docs€¦ · My Routine Sagittal Plane Count the interspinous spaces Choose the...
Transcript of My Routine - Broome Docs€¦ · My Routine Sagittal Plane Count the interspinous spaces Choose the...
1
My Routine
Sagittal Plane
Count the interspinous spaces
Choose the largest ligamentum flavum
Mark the level of insertionDirection of insertion
Transverse Plane
MidlineDirection of insertion
“All in one” View
Position Patient
Pre -scan
• Discussion with patient
• Ultrasound machine
• Curvilinear Obstetric probe (5-2MHz)
• Obstetric settings
• Depth 9-13cm
• Position the patient
• Sagittal Plane - Counting Levels.
• Start midline or just paramedian
• Sacrum is the only long flat bone, followed by a long shadow
• Ligamentum flavum is a window to the anterior wall of the canal, which is bone followed by a shadow
• Lamina is bone, followed by a shadow.
• Slowly and carefully scan up the back, counting levels.
•
Sacrum
Anterior wall of canal
Ligamentum flavum
Lamina
• Sagittal Plane - Choose the larger ligamentum flavum
• The size of the ligamentum flavum determines how much of the anterior wall can be seen.
• Small probe movments and angulations are needed to optimise the views of the anterior wall of the canal.
Anterior wall of canal
Ligamentum flavum
Lamina
• Sagittal Plane - Mark the level of insertion & determine the Direction of insertion in the sagittal plane
• “Heel Toe” the probe so the canal is horizontal across the screen.
• Move the probe so the ligamentum flavum of choice is in the middle of the screen
• Mark the back at the middle of the probe.
• The direction of the handle is the direction to advance the needle in the sagittal plane
Anterior wall of canal
Lamina
5
• Transverse Plane - Midline and the direction of insertion• The easiest and probably most valuable view
• Adjust the probe so the ultrasound image has - the spinous process shadow in the middle of the screen and so symmetrical anatomy is at an equal depth
• Then the middle of the probe is over the spinous process and the direction of the handle is the direction to advance the needle in the transverse plane.
633
• Transverse Plane - “All in one view”• Validated in published research• Scan slowly up and down the back to visualise the anterior wall of the spinal
canal. In this position there is no bone between the probe and the ligamentum flavum.
• Recheck (mark) midline and level of insertion. The angle of the probe is the direction to pass the needle in both the sagittal and transverse plane.
733
Anterior wall of spinal canal
Anterior wall of canal
Performing the Epidural
• Position the patient as you scanned the patient
• Use your routine clinical skills
• Palpate
• Long needle for local anaesthetic