The out-of-plane (short axis) approach offers the advantage of viewing lateral anatomy and allows the operator to redirect the needle tip when it veers in the wrong direction. However it is easy to lose track of the tip when it is out of the plane of the needle. Thus the needle may be deeper than suspected. In this image the operator neglected to follow the needle tip with the ultrasound beam, and the needle is actually much deeper (past the vessel). This can be seen as a bright echo passing through the vein down and to the left. Note that the needle is wiggling to highlight its location in this phantom. It is a bad idea to wiggle needles in a real patient!