Three tips for improving the ultrasound visibility of the needle tip (CVC).

If a needle has zero puncture resistance, there would be no tissue compression. Then, the techniques like Tip 1 are unnecessary. However, as mentioned in this video, it is necessary to advance the needle and probe alternately in order to confirm the needle tip position. So, the puncture method of "Continuously tracking the image of the needle tip from the beginning to the end" is like an armchair theory.
The best ultrasound setting should be determined in advance by performing a simulation with the ultrasound machine and needle that will be used in practice. Indeed, simulation makes perfect. I expect that the problem of black boxing of ultrasound machines will be solved in the future with improvements in the user interface due to artificial intelligence.

A nephrologist in Kyoto, Tadashi Kamata, MD

********** Contents of this video ***************
Click on the blue type below to jump to a specific stage of the video.
00:00 Disclaimer
00:16 Intro
00:22 Tip 1: Avoid compression of the tissue by the needle.
01:18 Actual case
02:47 Tip 2: Opimize the ultrasound frequency.
03:59 Tip 3: Place the bevel opening to face the probe.
04:35 Actual case
05:17 Conclusion
05:26 Caution
06:25 Ending

********* Keyboard Shortcuts (PC) ************
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********** Relevant papers & videos **********
Kamata T, et al. “Ultrasound-guided cannulation of hemodialysis access. Ren Replace Ther” 2016; 2:7 https://rrtjournal.biomedcentral.com/articles/10.1186/s41100-016-0019-1

Kamata T, et al. "Effects of transmission frequency and puncture needle properties on the ultrasonic visibility of the puncture needle tip: a fundamental study" J Jpn Soc Dial Ther. 2020;53:125-131 (in Japanese) https://www.jstage.jst.go.jp/article/jsdt/53/3/53_125/_pdf/-char/ja

Thomas S, et al. "The vanishing target sign: confirmation of intraluminal needle position for ultrasound guided vascular access" Acad Emerg Med. 2013 Oct;20(10):e17-8.

How to Safely Cannulate a Difficult Internal Jugular Vein on the First Attempt
https://youtu.be/UfKl2iVbrYs

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https://youtu.be/0r1rH7exYL4

Another Way of Locating the Needle Tip in Ultrasound-guided Deep Vein Cannulation
https://youtu.be/k_eXt1qs_2s

Видео Three tips for improving the ultrasound visibility of the needle tip (CVC). канала Ultrasound instruction video