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  • The deep fascia of the pectoralis minor muscle and the axillary artery are the most important ultrasonographic landmarks.
  • Abduct the arm 90 degrees to stretch the fasciae of the pectoralis muscles and facilitate its imaging.
  • A “heel-up” maneuver (rocks the transducer cephalad in a sagittal plane & depresses the tissue caudad to the transducer) facilitates needle insertion when clavicle comes in the way.
  • Aspirate every 3-5 mL to decrease the risk of intravascular injection.
  • As with all nerve blocks, never inject if the opening injection pressure is high (> 15 psi).