USG Interscalene Catheter Insertion (Arrow Stimucath) - Out-Of-Plane Technique

The OOP approach allows the needle to be advanced parallel to (rather than towards) the plexus. The catheter can be inserted a reasonable distance beyond needle tip (reducing tip dislodgement), lying alongside the plexus rather than wrapping around it; and its tip will lie more distally next to the superior trunk.
The exact sequence of steps varies with catheter make, but basic principles are the same. Here a catheter-through needle setup is used.
Technical tips:
- Tracking the needle tip in the OOP approach requires sliding the probe distally as the needle is advanced, rather than keeping the probe immobile.
- Probe and needle movements must be small and controlled.
- Skin stretch and application of counter-traction is vital for smooth and controlled needle insertion through mobile/loose tissues, especially for larger bore or less-sharp needles.
- Use indirect indicators of needle tip position - tissue motion, tactile feedback, and hydrolocation.
- In the OOP approach the most useful needle movements for tip localization are in-and-out jiggling and side-to-side waggling of the hub, looking for corresponding tissue and needle motion in the US image.
- Avoid excessive gel application, which can make equipment handling difficult (as can be seen!). Sterile saline is an alternative (and often better) contact medium in many USG procedures (e.g. CVP insertion) as it avoids the problem of slipperiness.

Note: All opinions expressed are my own, derived from personal observation, and shared to stimulate intellectual curiosity. They do not constitute professional medical advice. Viewers must assume full responsibility for their application.

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