Impact of Predefined Angles and a Revised APPLES Mnemonic on Accuracy and Performance Time for Simulated Ultrasound-Guided Injections.

Objectives: Our objective was to determine whether predefined angles would improve performance time and accuracy of ultrasound-guided procedures by novice operators and whether a revised APPLES (approach, position, perpendicular, lift, entry, sweep) mnemonic was a helpful guide for performing the procedure.

Methods: Participants attempted to hit targets in-plane and out-of-plane at different depths with a needle under ultrasound guidance with and without predefined angles. Participants were then asked if they thought that the mnemonic would be helpful when learning both methods for ultrasound-guided procedures.

A Simple, Realistic, Inexpensive Nerve Phantom.

Ultrasound-guided nerve blocks are common techniques in several medical specialties. Phantoms are commonly used when teaching these procedures. Commercial phantoms are expensive, and most previously published "homemade" nerve phantoms have a substantial amount of posterior shadowing, making it difficult to visualize the needle posterior to the simulated nerve.