Trick of the Trade: Cut IV extension tubing for 2-person ultrasound guided nerve block

Ultrasound-guided procedures are difficult enough just identifying the anatomy. Performing a nerve block with the ultrasound in one hand and the needle in the other hand adds extra challenges. The simplest 1-person approach involves attaching a syringe with local anesthetic directly to the end of the procedural needle. A 2-person approach involves attach the syringe to a custom tubing-needle setup such as below. However, this custom setup may not be readily available.

Trick of Trade: Cut Standard IV Extension Tubing

Required equipment:

• Ultrasound linear probe
• 10 cc syringe
• IV tubing
• Procedural needle
• Shears

Almost all standard IV extension tubing that connects IV fluid bags to a peripheral IV have an injection port near the downstream end.

1. Clamp the IV tubing just upstream from the injection port and cut off all the unused upstream IV tubing.
2. Attach a 10 cc syringe with local anesthetic to the injection port.
3. Attach the other end of this IV tubing (Luer lock attachment) to the procedural needle.
4. Prime the IV line with the anesthetic.
5. Perform the nerve block with one person advancing the needle under ultrasound guidance, while the other person aspirates and injects the anesthetic when needed.

Video: 2-person ultrasound-guided nerve block with cut IV tubing

Bonus Tip: This approach is applicable to many procedures requiring aspiration or instillation of anesthetic, such as peritonsillar abscess aspiration.

Read more from the Tricks of the Trade series.