title: Identification of location of nerve catheters using pumping maneuver and M-Mode-a novel technique.
abstract: BACKGROUND
  Optimum positioning of the nerve catheter is crucial for a successful nerve block. We present a novel technique for confirmation of catheter position.
  
  
  METHODS
  We are describing a novel technique for localization of the shaft and tip of the peripheral nerve catheter. After introduction of the catheter 3 to 5 cm beyond the needle tip and removal of the needle, the guide wire was reintroduced and was moved inward and outward rapidly. This movement produced the color Doppler effect along the track of the catheter and the catheter tip that helped us verify the proper positioning of the catheter.
  
  
  RESULTS
  We used our technique in a cadaveric study for bilateral supraclavicular brachial plexus block, followed by a series of 5 patients undergoing femoral, sciatic (anterior approach), popliteal (2 patients), and brachial plexus blocks. Catheters were also identified on M-Mode sonography during pumping maneuver and during the injection of medications.
  
  
  CONCLUSIONS
  Pumping maneuver and M-Mode can be additional tools in the array of modalities applied to verify proper positioning of a nerve catheter.
authors.affiliation: Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. Electronic address: elsharh@ccf.org.
authors.forename: Hesham
authors.initials: H
authors.lastname: Elsharkawy
authors.affiliation: Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Vafi
authors.initials: V
authors.lastname: Salmasi
authors.affiliation: Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Alaa
authors.initials: A
authors.lastname: Abd-Elsayed
authors.affiliation: Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Alparslan
authors.initials: A
authors.lastname: Turan
mesh_terms: D065527:Brachial Plexus Block / Q000379:methods; D002102:Cadaver; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D057785:Catheters; D006801:Humans; D009407:Nerve Block / Q000379:methods*; D010525:Peripheral Nerves / Q000000981:diagnostic imaging; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods
keywords: M-Mode; Peripheral nerve catheter; Pumping maneuver; Ultrasonography