Learning points from yesterday's renal biopsy

Some good radiologists and nephrologists appear to have faced problems
in the past during renal biopsy and they write,

 "Occasionally, after conventional ultrasound localization of the
kidney, the operating physician finds it difficult to determine
whether the biopsy needle has been positioned correctly, that is, with
the tip of the needle at or near the capsular surface of the kidney.

    In this circumstance, I have frequently seen attempts made to try
to visualize the relationship of the inserted needle tip to the
capsular surface for the kidney by positioning the transducer on the
patient's flank, lateral to the inserted biopsy needle,  and surveying
the ultrasound image to direct the final proper positioning of the
needle.

    It is my experience that this above described maneuver is rarely,
if ever, helpful.    The procedure seems logical and appropriate, and
I have no idea why the maneuver seems almost uniformly
non-productive." More here:
http://www.kidneybiopsy.com/technique/location.html

They suggest an innovative technique where a plastic needle guide is
attached to the transducer. See here
http://www.kidneybiopsy.com/technique/location_1.html

Here's a review on USG guided renal biopsy and further learning points
that i wish i had read up since i began doing these biopsies 14 years
back (albeit infrequently). :-)

Our needle gauge choice was wrong yesterday and that was responsible
for the small amount of tissue we obtained. We should go with 16G if
not 14 G. More here:http://www.ajronline.org/doi/pdf/10.2214/AJR.10.4427,
http://www.nature.com/ki/journal/v66/n4/full/4494783a.html,http://www.intechopen.com/download/get/type/pdfs/id/34940