Why? What is it about this guy that would make you prefer him over any other anesthesiologist? Because he makes youtube videos? What difference does that make in the operating room?
All anesthesia providers have all of this information & consideration (and more) in the back of their minds during their practice. It’s just the common person has usually no idea.
Here I am in academic medicine/epi-hoping that you will end up in academic medicine, or at least at a teaching hospital. You are superb at teaching. It is wonderful to see-after several decades on faculty I’ve seen none better than you.
This is so cool. Embarassingly, despite having had many procedures as a patient, I had no idea that it was only the plastic bit not the needle remaining in the vein. You illustrated the differences in gauges and the other placement considerations so well. Fantastic content, you are a great teacher.
Yea so you don’t need to worry about how you move. You’re not going to be poked from the inside. Hopefully, if you have to have more procedures, you’ll now know that you don’t need to worry about your IV site. I learned because I like watching them place it, and I’ve seen them remove the needle plenty of times.
You should still be somewhat careful. I had an IV kink, so they had to put in a new one. Though that may have been the fault of the nurse who put it in. Which reminds me, I'll be getting one on Wednesday for a test. Ya...
@@saphiriathebluedragonknight375no, it's not the nurses fault. Unless you've had your arm that way alot or if it's been in a few days. But a nurse inserting it cant kink it by putting it in. That I know of. 😊 no worries.
I'm a nightmare IV patient. My veins roll and nurses routinely blow all the way through as they dig around. After surgery I had IV in wrist that blew out and my hand and arm swelled with fluid. No pain meds were getting in. Each nurse tried twice to get IV and after 6 nurses and six hours with no pain control I was throwing up from pain. Finally next shift came on and charge nurse established the IV and I got some much needed relief. Bless you for knowing your stuff.
My husband is always a difficult patient when it comes to inserting an IV. Many times anesthesiologists get called in to establish the IV, perfectly and quickly every time. Thank you for what you do!
Having worked in the OR as a technician, I have seen many good anesthesiologists, and they are the controller of what happens during the surgery. They are the folks that say OK, you can begin. It is a job of boredom, interrupted with moments of sheer terror. After I worked for almost 20 years as a tech, I went to PA school and worked in the ER at night, where finding an anesthesiologist was rare. The ER docs I worked with were good doctors and good teachers as well. They taught me how to intubate and find IV access, and put in chest tubes, among many other chores which helped the patient, and got the patient ready to go to the OR. I was addicted to the drama. Working anywhere in the medical field is a job to be proud of. I have subscribed.
I love how Mount Sinai allowed you to use their equipment for the video! I just matched with Mt Sinai for my master's in genetic counseling and I have been wondering about their willingness to allow students/residents to film in their building, etc. I make videos mostly about my experience with EDS, but I'm hoping to do more genetic counseling content once I start at mt sinai in August!
😂 Izzy I love how we follow the same topics although I‘m too old and sick for another career. I wish you all the best for your new chapter and know you will be amazing in it!
Hi congrats on getting into the program! Sinai has a social media handbook that outlines how to approach things- it’s mostly common sense but important to check out nevertheless. Feel free to reach out on Instagram or email (mmf76@case.edu) if you have any questions!
Was a medic in the field for 25 + years. Know exactly what you mean about sizing up potential IV sites in random people. Just one of the weird habits you develop. There will be more. Another factor for consideration in IV placement is the need to splint the site and disable the patient over time since IV's that you place may remain for several days. Sure 18s for rapid fluid replacement are going into an AC, but as a patient, I would much rather have a 20 or smaller in a hand or anterior forearm so I could have use of that arm. More options for sleeping positions as well.
As a anesthesia professional myself- I am always looking at people's viens. I can say my accuracy is 99.9% I am a beast. Any place of course. I once had to start one a trauma patient in the Penis. NO LIE... Back in 1989
I've gotten a 14 while I was in the ER and the only anesthesia I got was, "Sorry, dude, not gonna lie, this is gonna hurt. " Their standing rule was that if you got an IV in the ER, you got a large gauge "just in case." (He was right. It hurt.)
Hahaha..That happened with me too during residency. Whenever I saw any big veins while commuting by train or walking on road, I used to guess which size of IV Cath can be placed comfortably in those vein😂😂! Very very nice video Doc.. ! Thank you so much.
I had a procedure a couple months ago and I told the anesthesiologist to put the IV in my hand but they decided to do it in my arm. They couldn’t get the catheter to thread through the vein and they decided to spare me from any more anxiety to just do the IV after I was out. I was happy to do that.
I've had to had laughing gas in the past many times, because after a few pokes I'm done. I've literally walked out of surgeries after fasting and everything, because the IV was so problematic. Hosptials in Utah are completley unsympathetic. So are the doctors. There appears to be an arrogance about the role of an Anesthesiologist. I know there are others like me. At the Huntsman Cancer Institute they had to have call in a helicopter nurse after 8 nurses from various floors/departments failed. He jabbed so hard that entire arm went black and blue over the next day or two. It hurt like hell but he got it in one jab. This a great video, but I'll never understand the lack of compassion for IV fear/panic/pain when the medical community is so empathetic to other fears surrounding medicine!!!
I was working at a teaching hospital when I had a procedure that required IV sedation. I'm guessing that I got a nurse in training for the IV insert, because she found every nerve and ligament in my hand before tapping a vein. The sacrifices we make for science!
It's important to point out that, as a rule, it's nurses who place IVs, and most doctors haven't placed one since their intern year. Anaesthesiologists are an exception to this.
As a blood donor with deep veins I find this totally fascinating because I’m typically stuck with 18 gauge needles for the donation process and due to my high pain tolerance from having sensory processing disorder ironically I find it quite an enjoyable experience strangely enough. I will say that making sure I’m extra hydrated makes all the difference in my veins cooperating for the donation because it’s easier for them to stick me when they’re more easily accessible. Also, I may not work in the medical field, but even I find myself jealous of other peoples veins and looking for “love marks” to see if they’re potentially a blood donor too 😂😂😂. (I’m almost at the 13 gallon mark so I have a ton of marks on my arms from my 100+ donations and one of the phlebotomists told me to call them love marks so that’s what I refer to them as now).
that hydration tip is good to know. i'm also a donor (still pretty new to it tho, im really young), and my veins are borderline impossible. it's gotten to a point where whenever i get blood drawn for donating or blood work or whatever, i have to apologize in advance because no one has ever been able to get it on the first try. next time i'll make sure to drink a lot of water before, hopefully that might make it easier on the poor nurses who have to go hunting for my vein
@@electricbaby7315 Exercise really helps in keeping good vein health as well, when I was very active nurses at blood drives could stick me with eyes closed because with few arm pumps I'd get a quarter inch tubes all over my arms. After year of inactivity and I had to get infusion pump hooked to my neck when ending in ICU and then an anesthesiologist nurse fish for deep vessels after that got unhooked too early. So,keep active for sake of both bone density and vessel health :)
It was funny when you mentioned always looking at peoples veins imagining what size IV you could get. As someone who has to start IV's on oneself to administer clotting factors, I find myself looking at peoples veins and being jealous of all the ivs I could probably get in there.
As an RN I cracked up about you mentioning looking at peoples veins and possible IV sites. I haven’t actually worked as a nurse for years but my eyes are still always out for people who have “good veins”.
I always stare at people’s veins 🤣 I’ll even compliment their veins. “Ooh you have such nice juicy ones!” With people I know, they know whenever I grab an extremity of some sort without warning, I am scouting their veins and admiring them haha
Dr. Feinstein, I am a young adult stroke survivor who has moyamoya syndrome; I have had many surgeries and your videos are informative and numerous. You are an excellent physician! Your videos are a mitzvah!
Haha the Neo comparison is SPOT ON. Had me cracking up! I remember when I started getting good at placing ultrasound-guided IVs and felt unstoppable in the ICU. Love watching your videos. They're helping me through CRNA school
God Bless America and our great health care staffed by well trained and caring doctors and staff. In spite of all the complaints about health care cost and access, we have the very best and are blessed. I am a cancer patient who sometimes feels like a pincushion, but I am getting great care and enjoy it! Thanks Max for your sharing your knowledge and training. It helps patients to understand what is happening and why.
I’m in my first medical school year and I love anesthesia and I want to be an anesthesiologist. Thanks to you I learn interesting things to be ready when the time comes. Greetings from Colombia.
Qhubo parcero im glad you’re enjoying the videos! Colombia has a spot in my heart, I did rotations at la PUJ in bogotá and also la ICESI. Best wishes on your journey
Congratulations on becoming a doctor!! That’s awesome!! I think of all areas of medicine, this is the best area. No cutting and you are the one making the patient feel comfortable before & after surgery. I’ve always loved every anesthesiologist that has been with me during surgery. I personally knew my anesthesiologist who was with me during my C-Section, and after 18 hrs of labor, 3 of which were pushing, I was exhausted…. I kept hearing awful beeping noises, and he kept me calm when my sweet husband couldn’t. If I looked at my hubby, I started crying, and they told me I couldn’t sob because it could shake me even though my bottom half was numb. He’s always been one of my fave people…. More women need to become anesthesiologists. In 12 surgeries, I’ve only had one woman.
Me too! I only have a couple veins that will actually take an IV without collapsing, and I’m always worried about what would happen if I lose one of them. Sometimes the anesthesiologist is the only person that can get one started. They are able to find veins I never knew existed. I went through septic shock, and had to get a large volume of fluid very quickly. I am glad I wasn’t awake for what I assume was a large IV. Might have been a central line, but I don’t remember, as I was in a coma.
I do the same thing when I walking the streets of New York City, if I see a person, I imagine how I would embalm him like what vessels would I choose to raise to shoot embalming liquid under reasonable pressure so that reachs at 90% of the body and that also involves me having to decide what embalming and non-embalming fluids that I will mixed in the embalming tank prior to shooting embalming fluid into the body using the “Right Carotid” as “Point Of Entry” and the “Right Jugular Vein” where the blood leaves after I give it a tiny snip after examining the body and confirming that the jugular has stop ejecting blood and is now ejecting embalming fluid and not blood tells me that the embalming procedure is going well. Then I stop and remove the cannula from the “Right Carotid Artery” from shooting down to now shooting up into the head at a very low pressure, keeping an eye on the left ear and waiting for that change to happen, where the left ear perks up and shows a slight natural redness to it and now I am comfortable that the entire body is embalmed and move on and I do a few more steps to prevent any purge from emerging from the mouth or nose of the decedent. After I do all that I sterilize the oral and nasal cavities and I then clean both cavities and then set the facial features and set their hands. Formaldehyde is an excellent preservative. Anyway there is a lot more I must do to get the decedent ready for his or her funeral. Too much to write in a “You Tube Video”. And I do the same I see someone and I wonder what they would look like laid out in a casket, it’s become second nature to me.
I do the very same 'search' as I look at people walking by, etc. If someone walks by with 'pipes' for veins, I quickly find myself saying (not out loud... too often!) " Yeah, I can get a 14 in that arm blindfolded!" Been out of the Advanced EMS field for 10 years but old habits simply don't go away, ever! Max, you do great work and keep educating us!
As an ER RN of over 30yrs I absolutely love a hard stick challenge. My tried and true trick is using a manual BP cuff instead of a tourniquet. Pump to appx 100mmhg or so, it has never failed me. Definitely relate to the Neo reference!! 😂
Do Anesthesiologists REALLY ever place IVs? Or is it most done by nurses or IV techs. I’ve spent more than my fair share of times in a hospital, and they’ve had people who do only IVs all day. They carry around a kit. And generally they are very good at it. I just can see any doctor place an IV.
@@maryannkom299 my anaesthetist placed my Iv in just before he put me to sleep then it was the nurse who removed it the following morning I think it depends on the doctor and their preference if they want to do it or have their nurses do it
@@maryannkom299 it just depends … as a retired OR RN we worked as a team. There were times when a CRNA was with the patient, the anesthesiologist would look in one arm and I would look in the other arm. Sometimes I would get it sometimes the Dr and sometimes the CRNA would just put in a line in the patient’s neck. It was all about the patient. Leave your egos at the door.
That thing of noticing people with excellent veins occurs to almost everyone who's done a phlebotomy rotation. It was one of the first things my best friend said to me when we first met, that my veins are incredible.
Hi Dr. Max, very very informative and I wish you were my anesthesiologist during my recent surgery. It was okay since I felt very comfortable with my Doctor who had explained so much to me and answered many questions that I had. When I had to make decision I selected surgery to have prostate totally removed and was done with robotic unit. My issue was in preop when they get you ready to roll into the OR. The nurse said she had to be IV in 1 arm and a backup in my other arm in case of emergency so it happened. It took her 3 tries and busted a vein before she did her job. The onto my left arm I was more than nervous if she could do a better job, but instead she excused herself and brought back another nurse to set up this IV and I was very happy. My surgery lasted 3 hours and I was most happy and now waiting these 60 days to be sure it was caught. I will view more of your videos and learn more. Thank you for your personal time and dedication!! I am sure your hospital and OR team are pleased to have you on the team during surgery and hopefully no crawling under the drapes to get toy our patient. God Bless! dwb
Today I begin the last year of my seventh decade and have had more surgeries than politicians have lies. YES please send One Stick Sally or Sam to put in my IV!!!
@@theoriginaljayz28 Oh Yeah! Before the only really botched surgery I ever had (Dr Hack N. Slash & crew), the nurse blew !!three!! veins before getting it right.... OTOH, twice I have had IV insertion with zero pain. Unbelievable! Both were from an RN.... One Stick Sally!!!
I'm having a Colectomy on Tuesday May the 16th. I have Complicated Sigmond Diverticulitis and a Fistula to my Bladder and my surgeon thinks I probably have Colon Cancer as well. I'm 37 years old and this is my first Major Surgery. Thank you for all of these videos that I have been educating myself a bit on the last few days. Feeling much more relaxed and comfortable going into surgery. Thank you!
This is a stellar video. 👌 Nothing left out and you made it look effortless. (As a nurse I appreciated the need for the facility shout out for supplies)
You are such a great Dr!! You explain everything so well!! It would be awesome to be as smart as you, and to have such a rewarding job! I wish you were here an anesthesiologist here in a Pittsburgh pa hospital. I would definently request you for my surgery!
Retired RN here. Back in the 90's I was a medical supervisor at a large prison here in Texas. Best experience ever. One day we get a call that an inmate was in status epilepticus. He was a muscular guy who could play linebacker for any NFL team. We go pick him up and bring him back to the medical unit. He was seizing big time. I needed to start an IV.... there is no doc 24/7. There was only ONE reasonable location, literally, the external jugular vein. In goes the needle and in goes the Valium 10 mg at a time. Over 45 minutes or so he got probably 60-70 mg before he stopped seizing. You have to remember this a prison. You just can't call ems, they roll to the gate and you toss the guy in for a trip to the hospital. Considering the SE and lack of O2 you do what you have to do. We saved him and he slept like a baby for a day or 2.
A someone who has an er Dr take 7+ tries to get an iv in when my blood pressure was crashing, I deeply appreciate anyone who is skilled in placing iv's or drawing blood
This helps me understand how anesthesia works. I need a hip replacement and have lower back spine issues. 😫 when the time comes I will know what to expect. Wish I could have this doctor. I have never had surgery before. Thank you.
Your videos came up in my recommendations as I was looking for information on hysterectomies (I'm having one in little over a month). I watched a few and I was hooked! My veins are notoriously bad and uncooperative; last time I got an IV it took 13 sticks (including in both my feet, that HURT) and eventually they gave up and gave me a central line (which was so cool, I'm a nerd >.>;;) I'm hoping my veins cooperate for surgery next month. Thank you for all of your informative videos, looking forward to the central line video. Take care, get some rest when you can and have a very nice day :3
Thanks for sharing. I'm most thankful to the anesthesiologist who took my feedback seriously, to avoid wrist joint when setting IV, cause I needed my arms to help me move in bed for prolong period after fractured femur. Felt so sorry that I didn't get to see him / her as I wasn't wearing my specs in OT 😅 Felt sorry for not able to thank the anesthesiologist after I wok up from surgery.
I'm a NICU nurse, and I was laughing at the 24g being tiny. I knew other disciplines think 26g are small, but 24g is our go-to size. We virtually never place anything larger peripherally. But also, we never give fluids anywhere near 22ml/min.
I'm not really a Doctor and don't play one on TV either... but you are a Great Doctor with a very bright future. You 'bedside manners' must be awesome, because your ability to explain complicated concepts in everyday terms is appreciated by your patients.
Hi Max great video. Could you give some pointers on unconventional IV sites for difficult patients or tricks on cannulation for chemotherapy, geriatirc, obese patients.
Hi Samuel, thanks for watching. My go-to spots for the patients you mentioned: - Chemo: Literally anything I can find. Sometimes have luck with the course of the basilic vein in the forearm. - Geriatric: Usually AC fossa, sometimes using ultrasound with a longer IV so I can get further down into a deeper/larger vein like the basilic. These veins don't move around as much on me as compared to hand veins in these patients. - Obese: Hand IVs actually tend to be easy to find.
Max, I’m just a lay guy who likes to watch medical shows such as Chicago MED & Grey’s Anatomy. I’ve listened to all of your videos, and not just because they’re interesting, but you explain things that an average non-medical guy can understand, at least about 98% of it. Now, when they’re barking out orders on television, and rattling off medication‘s in the ED, I actually understand exactly what’s going on… what those medications do, and why they’re being administered…even if a lot of it is done for dramatic affect. I have loved watching your series both as an educator for a fictional television show fan, and as a potential future patient… All valuable information and fascinating as well!
Wow! Great topic. I often wonder about IV during any procedures particularly surgery. Consideration is a proactive approach particularly is the patient has issues with veins..Such as, rolling, line blowing, and incorrect insertion of IV. I often wonder if the size of IV is important too. Excellent video and informative.! Stay safe.😁
I have nothing to do with anything medical, I was a teacher for 33 years, but for some reason I find all your videos fascinating. I am supposed to have a hysterectomy due to post menopausal bleeding but here in Ontario, Canada we are under stay at home orders, our ICUs are overrun with COVID-19 patients and who knows when this surgery will happen. In the past I once had to have a nurse come from the cancer unit to me in Emerg to put my IV in because I needed a blood transfusion for anemia
Left BC here. Finished Chemo October, no port, hard stick, thank God for Ultrasound guided IV. Except once during blood work at a E.R. The Ultrasound tech after she started to jab me stated they do no numb the area first. Wow. I just started watching all your videos you make it very interesting I didn't realize there were so many aspects. Thank you.
My hospital had its own blood bank and occasionally the surgeon decided after the patient got to pre-op holding that she/he wanted the patient to get a type and cross match done. I worked as an RN in the blood bank. I went down to pre-op and since I had to stick the patient for the TCM, I often put in an 18g needle to get the blood sample and flush the needle in the forearm so it could be used by the NA or anes. MD. I always checked to see which side the patient would be getting the procedure done so the IV line wouldn’t be in the surgeons way.
Very informative! As a patient, however, I find IVs in the antecubital fossa hurt the most. And whenever you bend your arm it sets off the alarm on the IV pump.
@@NataliaPessoaXOXOMAKE yess! My hand was terrible, they had to try 5! times. Also, when I was going “to sleep” the anesthesia hurt like hell! The following surgeries I requested an elbow IV, did not hurt at all! Placement did not hurt & going to sleep did not hurt.
FYI: Why needle size goes down while the gage number goes up: It refers to how many times the tube has been drawn. The manufacturer receives a tube of one size, usually the equivalent of a zero gage, and draws it through a series of ever smaller dies till the desired target is reached. How many times this is done is the gage number. So for a #14 needle, or 14 gage, the starting tube has been drawn down 14 times.This is the same for wire and sheet metal.
I'm always so thankful to see the Anesthesiologist prior to any surgery I've undergone, and unfortunately I've had a dozen; but that's what has taught me to appreciate them. I'm pretty zen about everything in the OR, having been a Scrub, except for IV placement. My hands are notorious for infiltration, so though it's more painful, I always ask for cephalic or basilic placement whichever they want. Also, because of my history of resus in surgery, I've always told them to err on the side of higher volume vs. higher gauge. A few have laughed, and a few have looked smugly disbelieving. None have come back later to tell me I was wrong. As far as I'm concerned, the surgeon works for them, not the other way around. It's never been my surgeon trying to reinflate my sticky, damaged asthmatic lungs (nope, never smoked anything but second-hand), deal with my extreme hypoglycemia (my normal glucose level hovers around 65 and I've walked into an OR suite with it at 30 - no lie) from lack of overnight nutrition or quickly insert a central line when God knows what happened due to my venous insufficiency. It's always the anesthesia team. The only thing I wish is that I could be fully conscious but fully numb for everything. There's nothing I haven't seen, heard, or smelled in an OR anyway. My last word: Send me some weird dreams, Doc. I gotta try and take something away from this other than a new scar and a frozen butt".😅 I think your videos are a great patient education tool. Too bad there's usually not enough time before the OR for many to see them.
As a former RN, I can ABSOLUTELY relate to subconsciously looking at peoples veins and wishing I was starting an IV on some of them. My oldest son has the biggest veins. I could throw a 16 like a dart across the room and get proper placement in his vein smh. I refuse AC IVs (on myself mostly), so Im a pain. They just get kinked too easily, set off the pump and a nurse is never around to silence it. Plus, on the nursing end, nothing worse than being behind, finally sitting down to chart and 2 patients' pumps start beeping. It's very rare another nurse will be willing to fix it for you. But ACs are so easy and strong to start an IV. My veins are so scarred there from SO many IVs.
I’ve had a large bore IV placed awake without numbing medication 🤣 wasn’t fun, but was an emergent situation where access was needed so there wasn’t time to screw around. Usually IV’s and blood draws don’t bother me at all. That one was quite a bit worse but I breathed through it and was fine. Thankfully I have a high tolerance for pain and needles don’t freak me out. Had I been afraid of needles or super sensitive to pain, I could see how someone might hit the floor 🥴
I'll be applying to anesthesia this fall and I really appreciate your videos. I started watching them when I was on the fence between IM and anesthesia, and here I am :) Do you have any plans on doing a video about intubations? I would love to learn to be better at them!
I loved your video about placing an IV during surgery. Sometimes my veins are hard to find and they tend to move a lot and they have to be placed in my neck which you didn't mention in this video. You didn't mention that you don't ever place an IV in a patient's neck that's difficult to stick.
Thanks for the post! Honestly! I wish I knew the IV was a flexible tube! I have always thought I had a sharp metal tube in my IV so I feared moving. Now I can know that any discomfort is just the very flexible tubing and not a metal tube cutting through my vein anytime I moved. Thanks!
Gosh my husband's in hospital. A CT showed a 5.6cm AAA . His surgeon seems so caring. They had to do a kidney prep for a different type of ct with a potent contrast . There doing surgery mon as they need his labs better. I PRAY TO GOD he gets a anesthesiologist just like u! 🤗🙏🙏❤
My daughter had to have a surgery while in NICU at 2 months old. She barely weighed 5 pounds so it was scary. Her team was great and her anesthesiologist saved her life. The IV they stated using to put her under was misplaced by the time of surgery and the drugs were injected into her muscle. He noticed right away and was able to compensate and make sure she didn't overdose. Also, the IV sizes for infants are miniscule! I don't know how the RNs could get them in!
Very interesting! as a nurse myself, im concern about the location too, but the concern lies in avoiding joints like AC fossa or wrist, as patients may be mobile and moving. Frequent movement tend to 'kill' the IV access too.
And it can scratch up the inside of the vein - almost 3 years later, one that was placed basically in my wrist (it wasn't done right), the vein is still suffering, and it was only in for about 5 hours (I was awake the entire time that it was in - not surgery).
I have no idea how I got here, but i am enjoying these videos and learning a lot. I’ll be much more informed if I ever have to go under the knife. Thanks for the info and entertainment doc!
Oh my gosh. I’ve had 12 surgeries, 4 spinal surgeries, a double mastectomy with node dissection, I’ve had ENT surgery.... oh my goodness... the list goes on. I have few good veins and he hit on all of them.
Cool stuff man ! I just finished my Anesthesia rotation as an ED resident. Really good experienced, learned a lot of techniques for intubation and also placed some IV's !
Having been on the receiving end of many iv's and anaesthetics this was interesting. I don't have any good veins available and as soon as they blow that vein on the first try I know how it's going to go. I'm happy when they usually decide to use gas and put the iv in when I'm asleep, especially when I wake up and it's in my ankle 😮
@@truthBtold-ld5sd it's not my call. They'll try for an IV 2 or 3 times but when they realise how difficult it's going to be they opt for gas. They don't want to cause more pain than they have to. Downside to gas is it makes me sick afterwards and you can taste it for days but at least it's painless lol
Glad to see you are making videos again! I matched for a veterinary anesthesia residency at university of Georgia starting this summer. Hope your residency is going well!
Congratulations, really glad to hear that! Best wishes for residency and please keep me posted on how it goes. I would love to do a vet anesthesia rotation.
My son had a long and complex head surgery, and came out with a cannula in each extremity (hands, feet), in each elbow, in his femoral artery, an artery in his wrist, and they took out a needle in his forehead before he left the OR. He needed two full blood transfusions, and the anaesthetist called for the surgery to end at that point for my son’s safety. It must have been so complex for the anaesthesia team, with so many different components to monitor and manage. I knew in all his subsequent surgeries that the anaesthesia team would take care of him, keep him safe and comfortable, and that was very reassuring.
The most painful iV location is the Wrist! I never again went for a wrist on anyone after I experienced it myself! I rarely get to insert cannulas anymore. working ambulance during Mschool, I did go in with a 24g a few times, sadly!
The last time I had an IV, the nurse who did it had never done one before - she was supposed to do it in the back of my right hand (I'm R-handed, but the veins on the back of my left hand are spidery; I'm fine with blood draws in the AC, but I can't keep my arm straight for very long, so AC is totally out for an IV, and they let me pick where to get it, anyway), but she started it a good 1/2"-3/4" too high, and the pain from the end of the cannula scratching around in the vein at my wrist was enough to make it impossible for me to use that hand at all - almost 3 years later, where it scratched is still slightly sore if I rub it just right. It was so painful getting it put in (I'm sure if it had been done in the correct spot and the correct way, it would have been fine - that nurse had absolutely no idea what she was doing, even though she had an experienced nurse there talking her through it; I get that people have to learn somehow, but I was still very unamused to be the guinea pig in that situation, since they didn't tell me beforehand that it was her first time, and the last time I'd had an IV before that, I was too young to remember it) that the only thing I've had done that hurt more was getting a stubborn wisdom tooth pulled basically without any anesthetic. All that to say, thank you for not doing it in the wrist!!
Great video! I learned it only recently by asking the question at the hospital while they were placing a catheter on me and I think patients should be explained that the needle of IVs doesn't stay inside! I'm sure many don't know it and psychologically knowing it reduces a lot of the anxiety of IVs I think. My fear used to be that the needle would wreak havoc inside of me if I moved. Once I knew it was only a flexible piece of plastic tubing that stayed I was WAY more at ease with IVs.
Thanks so much for explaining all this! I always ask for the IV not to be placed in the top of my hand because it's so painful in that spot. Most of the time they can accommodate me. You weren't kidding when you said propofol can sting going into your veins. I had one unforgettable experience where it felt like a blowtorch on my arm! I swore like a sailor.
Good to see you again Max!! Great video! I love learning this stuff about anesthesia…I just had a second kidney stone surgery Monday…actually it was scar tissue in my ureter. I will have the stent at least 4 weeks this time so I can heal around the stent. I think it will go well!! Thanks for the info and have a great day!
My experience regarding placing an IV in the hand. Since I have very large, easily accessible veins, when I had an IV placed in my hand, it actually caused irritation when I was using my hand for basic things like using my phone or laptop while I was recovering from surgery, which, after not too long, also lead to a bit of bleeding because of the tugging and snagging. I had to ask the nurse to move it further up my arm because of this.
Pain from IV insertion in the hand can be completely eliminated by injecting a very small amount of local anesthetic with a very small bore, 28-30 gauge, needle, prior to insertion of the IV.
In the chain of mega hospitals in my area, the lidocaine pretreatment is only used for larger sizes, not the typical IV. You would think they'd want to do it every time so as to bill me for it. Since they don't, it can only mean that most insurances don't cover it. But why would the insurance company deny $4.26 for lidocaine but pay 100% for an ultrasound vein finder?
Retired OB nurse. We cared for a lot of high risk patients. Our anesthesia head wanted us to use minimum of an 18g, whenever possible. Those OB cases can change gears very quickly.
I’m a hard stick, but the best advice I’ve ever gotten is to truly relax and mean it! I’ve had people flippantly tell me to relax, and three sticks later, we finally have an IV. I once had a nurse approach, recognize my fears, and then speak softly, calmly and got me to relax completely before inserting the IV… on the first stick. Pre-op areas are often noisy and busy, which does not help us to relax.
A nurse or doctor who is calm and has a soothing voice makes all the difference. I HATE needles but can usually breathe through it. I appreciate the good nurses so much.
Thank you doc. I've had a couple surgeries and met the anesthesiologist prior to surgery but you never know what questions to ask. So it would be nice to ask what the plan is going into surgery and know what the doctor is talking about. Keep up the good work and thank you again.
This was such a great explanation. I know now why I have to sit in the infusion chair all day for my immunosuppressive treatment every month. I’m curious would you ever give anesthesia through a port? I’ve had mine for over a decade and I’ve always been curious about that!
You gave me a lot of info that I had questions about. I still do have some questions so will continue to view your great videos, and see if you have answered them.
I absolutely love ur vids! Ur hospital must be really supportive of u making these vids that’s awesome! Btw when would u use that huge Iv? Maby a trauma case where they need a large volume really fast. Take care bud.
Thanks Mike, yes the hospital and especially the Mt. Sinai Anesthesiology dept are very supportive. Big IVs like that for trauma, big orthopedic or neurosurgeries, some OB surgery, liver transplant, sepsis -- just some examples that come to mind.
I had to have a couple 14G needles for trauma surgery due to a motorcycle accident (broke my ribs which lacerated the splenic artery ). They were pushing fluids like crazy (fortunately I was able to use a cell saver during surgery....but they had 6 pints of blood if needed). My hat's off to my anesthesiologist....he had to hurry...he was intubating me while putting me out and never skipped a beat....great trauma team.
This reminds me of one time I was in the ER. I was in the ER due to tachycardia (ended up being due to dehydration), so they placed the line and took me to imaging. They took me in for CT with contrast (which I had to document as an allergy because of how severe my nausea is after it processes), and hooked me up for it. After that, I was given a bag of saline and sat and waited… and waited… and waited… I asked the attending when I could be discharged and they said after I finished the bag. When they came in to remove the cath, they realized they had been using the contrast dye stuff which is much smaller gauge. They apologized because while it didn’t have any clinical contraindications in the end, it meant it took longer to rehydrate, which meant longer ER stay.
I've been told by nurses and doctors on multiple occasions that I apparently have beautiful veins 😄 Pro-side: So far, no one has ever missed a vein when drawing blood or placing a line. Con-side: I've been asked multiple times whether it's okay if the new trainee places the line since apparently my veins are hard to miss
Great video man! I learned a lot about Anesthesiologist, I tried to go to college to be a Anesthesiologist but it was gonna be too hard because of my cerebral palsy! Keep up the great work
love all your videos. I am too old now, retired but had wanted to be an anesthesiologist if I could have gone to medical school. I did get into radiology, at the time I went to school it was free in the hospital but we also worked in radiology some 40 hours each week. No such program around today.
I'm an older dentist that offers outpatient IV sedation. I stumbled across your channel some time ago, became intrigued and have now watched most of your journey through residency. [1] Quick question regarding lymph node dissection. I never place an IV on the same side as my auto-BP. Consequently, for patients that have undergone lymph node dissection, I usually place the IV on the side of the dissection to avoid the need to take BPs on that side. Bear in mind, (in contrast to your needs) I'm dealing with extremely small volumes of fluid. For extended dental cases I want barely enough fluid to keep the line patent. Otherwise, in a 3-hour case the patient will show signs of needing to urinate. (LOL) Your thoughts about IV and BP placement? [2] I thought I was the only person that walked around looking at people and thinking, "Yeah, that's an easy placement." or "Wow, I hope I'm not doing one on them."
Thanks for following along with my videos! Great question-- in the scenario you describe, I would probably opt to put the IV and BP cuff on the same arm, Since you said the IV is running a minimal amount of fluid (and I'm assuming few/no other medications) it sounds like it wouldn't be detrimental to have it occluded once every 3-5 minutes. Having said that, the risk of lymphedema is so low that your approach sounds reasonable as well.
One thing I think some people in the medical field don't always consider is patient input. A 23 gauge can be used to draw blood from my hand, once; it always blows the vessel. My right AC pops out more than the left but the left is more patent. PICC lines for me are better on the left because of damage on the right from a previous PICC. Fishing will make me vomit and pass out. I've never had an IV in the forearm that they could get first or second stick. The only one I've had was placed while I was under. I feel that if the patient can tell you those types of things that their input should be considered. Also, replacing catheters that are patent in a long-term hospitalization just sucks. Both hands and left AC blew out and so did both basilic veins and they wanted to replace a patent 20 gauge in the left arm and spent 15-20 minutes with a vein scanner and decided to just leave it.
If I had a choice, I'd want this guy taking care of me during surgery!
with my luck I'd be the star of the video how to take a patient to the brink of death and (hopefully) bring him back
Why? What is it about this guy that would make you prefer him over any other anesthesiologist? Because he makes youtube videos? What difference does that make in the operating room?
All anesthesia providers have all of this information & consideration (and more) in the back of their minds during their practice. It’s just the common person has usually no idea.
Same
@@saxaphonehero11 “Hey guys in this video we’re going to see if I can almost kill man and then resuscitate him.”
Here I am in academic medicine/epi-hoping that you will end up in academic medicine, or at least at a teaching hospital. You are superb at teaching. It is wonderful to see-after several decades on faculty I’ve seen none better than you.
This is so cool. Embarassingly, despite having had many procedures as a patient, I had no idea that it was only the plastic bit not the needle remaining in the vein. You illustrated the differences in gauges and the other placement considerations so well. Fantastic content, you are a great teacher.
Yea so you don’t need to worry about how you move. You’re not going to be poked from the inside. Hopefully, if you have to have more procedures, you’ll now know that you don’t need to worry about your IV site. I learned because I like watching them place it, and I’ve seen them remove the needle plenty of times.
You should still be somewhat careful. I had an IV kink, so they had to put in a new one. Though that may have been the fault of the nurse who put it in. Which reminds me, I'll be getting one on Wednesday for a test. Ya...
@@saphiriathebluedragonknight375no, it's not the nurses fault. Unless you've had your arm that way alot or if it's been in a few days. But a nurse inserting it cant kink it by putting it in. That I know of. 😊 no worries.
@@floralmist6824 I only had it for a few hours. Less than a day at most. Must have been my fault then.
I'm a nightmare IV patient. My veins roll and nurses routinely blow all the way through as they dig around. After surgery I had IV in wrist that blew out and my hand and arm swelled with fluid. No pain meds were getting in. Each nurse tried twice to get IV and after 6 nurses and six hours with no pain control I was throwing up from pain. Finally next shift came on and charge nurse established the IV and I got some much needed relief. Bless you for knowing your stuff.
How lucky your patients are. Even this layman understands these concepts perfectly when you explain them.
My husband is always a difficult patient when it comes to inserting an IV. Many times anesthesiologists get called in to establish the IV, perfectly and quickly every time. Thank you for what you do!
GREAT JOB! As an RN who started MANY IVs, you explained things very well! You are going to be GREAT as an anesthesiologist! 💙
Having worked in the OR as a technician, I have seen many good anesthesiologists, and they are the controller of what happens during the surgery. They are the folks that say OK, you can begin. It is a job of boredom, interrupted with moments of sheer terror. After I worked for almost 20 years as a tech, I went to PA school and worked in the ER at night, where finding an anesthesiologist was rare. The ER docs I worked with were good doctors and good teachers as well. They taught me how to intubate and find IV access, and put in chest tubes, among many other chores which helped the patient, and got the patient ready to go to the OR. I was addicted to the drama. Working anywhere in the medical field is a job to be proud of. I have subscribed.
I love how Mount Sinai allowed you to use their equipment for the video! I just matched with Mt Sinai for my master's in genetic counseling and I have been wondering about their willingness to allow students/residents to film in their building, etc. I make videos mostly about my experience with EDS, but I'm hoping to do more genetic counseling content once I start at mt sinai in August!
😂 Izzy I love how we follow the same topics although I‘m too old and sick for another career. I wish you all the best for your new chapter and know you will be amazing in it!
@@juliaspoonie3627 hahahahah so funny. and thanks so much Julia!
Hi congrats on getting into the program! Sinai has a social media handbook that outlines how to approach things- it’s mostly common sense but important to check out nevertheless. Feel free to reach out on Instagram or email (mmf76@case.edu) if you have any questions!
@@MaxFeinsteinMD thanks so much! I definitely will!
Was a medic in the field for 25 + years. Know exactly what you mean about sizing up potential IV sites in random people. Just one of the weird habits you develop. There will be more. Another factor for consideration in IV placement is the need to splint the site and disable the patient over time since IV's that you place may remain for several days. Sure 18s for rapid fluid replacement are going into an AC, but as a patient, I would much rather have a 20 or smaller in a hand or anterior forearm so I could have use of that arm. More options for sleeping positions as well.
You may be a newer Anesthesiologist, but you definitely have a gift for clear, concise teaching!!! 👍❤️
As a anesthesia professional myself- I am always looking at people's viens. I can say my accuracy is 99.9% I am a beast. Any place of course. I once had to start one a trauma patient in the Penis. NO LIE... Back in 1989
I've gotten a 14 while I was in the ER and the only anesthesia I got was, "Sorry, dude, not gonna lie, this is gonna hurt. "
Their standing rule was that if you got an IV in the ER, you got a large gauge "just in case."
(He was right. It hurt.)
Hahaha..That happened with me too during residency. Whenever I saw any big veins while commuting by train or walking on road, I used to guess which size of IV Cath can be placed comfortably in those vein😂😂!
Very very nice video Doc.. ! Thank you so much.
I had a procedure a couple months ago and I told the anesthesiologist to put the IV in my hand but they decided to do it in my arm. They couldn’t get the catheter to thread through the vein and they decided to spare me from any more anxiety to just do the IV after I was out. I was happy to do that.
I've had to had laughing gas in the past many times, because after a few pokes I'm done. I've literally walked out of surgeries after fasting and everything, because the IV was so problematic. Hosptials in Utah are completley unsympathetic. So are the doctors. There appears to be an arrogance about the role of an Anesthesiologist. I know there are others like me. At the Huntsman Cancer Institute they had to have call in a helicopter nurse after 8 nurses from various floors/departments failed. He jabbed so hard that entire arm went black and blue over the next day or two. It hurt like hell but he got it in one jab. This a great video, but I'll never understand the lack of compassion for IV fear/panic/pain when the medical community is so empathetic to other fears surrounding medicine!!!
I was working at a teaching hospital when I had a procedure that required IV sedation. I'm guessing that I got a nurse in training for the IV insert, because she found every nerve and ligament in my hand before tapping a vein. The sacrifices we make for science!
Hence why it's a "teaching" hospital ;) Thank you for your sacrifice.
It's important to point out that, as a rule, it's nurses who place IVs, and most doctors haven't placed one since their intern year. Anaesthesiologists are an exception to this.
As a blood donor with deep veins I find this totally fascinating because I’m typically stuck with 18 gauge needles for the donation process and due to my high pain tolerance from having sensory processing disorder ironically I find it quite an enjoyable experience strangely enough. I will say that making sure I’m extra hydrated makes all the difference in my veins cooperating for the donation because it’s easier for them to stick me when they’re more easily accessible. Also, I may not work in the medical field, but even I find myself jealous of other peoples veins and looking for “love marks” to see if they’re potentially a blood donor too 😂😂😂. (I’m almost at the 13 gallon mark so I have a ton of marks on my arms from my 100+ donations and one of the phlebotomists told me to call them love marks so that’s what I refer to them as now).
As a transfusion recipient thank you for donating.
that hydration tip is good to know. i'm also a donor (still pretty new to it tho, im really young), and my veins are borderline impossible. it's gotten to a point where whenever i get blood drawn for donating or blood work or whatever, i have to apologize in advance because no one has ever been able to get it on the first try. next time i'll make sure to drink a lot of water before, hopefully that might make it easier on the poor nurses who have to go hunting for my vein
@@electricbaby7315 Exercise really helps in keeping good vein health as well, when I was very active nurses at blood drives could stick me with eyes closed because with few arm pumps I'd get a quarter inch tubes all over my arms. After year of inactivity and I had to get infusion pump hooked to my neck when ending in ICU and then an anesthesiologist nurse fish for deep vessels after that got unhooked too early. So,keep active for sake of both bone density and vessel health :)
You are such an excellent teacher and speaker. I thoroughly enjoy these videos. Thank you!
Wow, thank you!
It was funny when you mentioned always looking at peoples veins imagining what size IV you could get. As someone who has to start IV's on oneself to administer clotting factors, I find myself looking at peoples veins and being jealous of all the ivs I could probably get in there.
Wow that's an interesting perspective!
As an RN I cracked up about you mentioning looking at peoples veins and possible IV sites. I haven’t actually worked as a nurse for years but my eyes are still always out for people who have “good veins”.
I always stare at people’s veins 🤣 I’ll even compliment their veins. “Ooh you have such nice juicy ones!” With people I know, they know whenever I grab an extremity of some sort without warning, I am scouting their veins and admiring them haha
Dr. Feinstein, I am a young adult stroke survivor who has moyamoya syndrome; I have had many surgeries and your videos are informative and numerous. You are an excellent physician! Your videos are a mitzvah!
Fascinating. Knowledge erases fear. Thanks for your videos.
"Facts fight fear."
Haha the Neo comparison is SPOT ON. Had me cracking up! I remember when I started getting good at placing ultrasound-guided IVs and felt unstoppable in the ICU. Love watching your videos. They're helping me through CRNA school
God Bless America and our great health care staffed by well trained and caring doctors and staff. In spite of all the complaints about health care cost and access, we have the very best and are blessed. I am a cancer patient who sometimes feels like a pincushion, but I am getting great care and enjoy it! Thanks Max for your sharing your knowledge and training. It helps patients to understand what is happening and why.
I’m in my first medical school year and I love anesthesia and I want to be an anesthesiologist. Thanks to you I learn interesting things to be ready when the time comes.
Greetings from Colombia.
Qhubo parcero im glad you’re enjoying the videos! Colombia has a spot in my heart, I did rotations at la PUJ in bogotá and also la ICESI. Best wishes on your journey
Congratulations on becoming a doctor!! That’s awesome!! I think of all areas of medicine, this is the best area. No cutting and you are the one making the patient feel comfortable before & after surgery. I’ve always loved every anesthesiologist that has been with me during surgery. I personally knew my anesthesiologist who was with me during my C-Section, and after 18 hrs of labor, 3 of which were pushing, I was exhausted…. I kept hearing awful beeping noises, and he kept me calm when my sweet husband couldn’t. If I looked at my hubby, I started crying, and they told me I couldn’t sob because it could shake me even though my bottom half was numb.
He’s always been one of my fave people…. More women need to become anesthesiologists. In 12 surgeries, I’ve only had one woman.
@@theoriginaljayz28 that’s a great comment 🤗
@@RaccoonNation thank you. That was so sweet of you to tell me. I truly think anesthesiologists have the best bedside manner.
As a ✨ difficult patient ™✨ with a lot compound issues that affect how IVs work for me, this is really fascinating, thank you.
Thanks for watching!
Same here
@@MaxFeinsteinMD Excellent video. Getting an iv is the most painful part of being put to sleep for a test, surgery, or diagnostic procedure.
@@sonjakettles3057 I didn’t see a question in your comment though.
Me too! I only have a couple veins that will actually take an IV without collapsing, and I’m always worried about what would happen if I lose one of them. Sometimes the anesthesiologist is the only person that can get one started. They are able to find veins I never knew existed. I went through septic shock, and had to get a large volume of fluid very quickly. I am glad I wasn’t awake for what I assume was a large IV. Might have been a central line, but I don’t remember, as I was in a coma.
I do the same thing when I walking the streets of New York City, if I see a person, I imagine how I would embalm him like what vessels would I choose to raise to shoot embalming liquid under reasonable pressure so that reachs at 90% of the body and that also involves me having to decide what embalming and non-embalming fluids that I will mixed in the embalming tank prior to shooting embalming fluid into the body using the “Right Carotid” as “Point Of Entry” and the “Right Jugular Vein” where the blood leaves after I give it a tiny snip after examining the body and confirming that the jugular has stop ejecting blood and is now ejecting embalming fluid and not blood tells me that the embalming procedure is going well. Then I stop and remove the cannula from the “Right Carotid Artery” from shooting down to now shooting up into the head at a very low pressure, keeping an eye on the left ear and waiting for that change to happen, where the left ear perks up and shows a slight natural redness to it and now I am comfortable that the entire body is embalmed and move on and I do a few more steps to prevent any purge from emerging from the mouth or nose of the decedent. After I do all that I sterilize the oral and nasal cavities and I then clean both cavities and then set the facial features and set their hands. Formaldehyde is an excellent preservative. Anyway there is a lot more I must do to get the decedent ready for his or her funeral. Too much to write in a “You Tube Video”. And I do the same I see someone and I wonder what they would look like laid out in a casket, it’s become second nature to me.
I do the very same 'search' as I look at people walking by, etc. If someone walks by with 'pipes' for veins, I quickly find myself saying (not out loud... too often!) " Yeah, I can get a 14 in that arm blindfolded!" Been out of the Advanced EMS field for 10 years but old habits simply don't go away, ever! Max, you do great work and keep educating us!
As an ER RN of over 30yrs I absolutely love a hard stick challenge. My tried and true trick is using a manual BP cuff instead of a tourniquet. Pump to appx 100mmhg or so, it has never failed me. Definitely relate to the Neo reference!! 😂
Warm blankets wrapped for a few minutes also does wonders!
Do Anesthesiologists REALLY ever place IVs? Or is it most done by nurses or IV techs. I’ve spent more than my fair share of times in a hospital, and they’ve had people who do only IVs all day. They carry around a kit. And generally they are very good at it. I just can see any doctor place an IV.
@@maryannkom299 my anaesthetist placed my Iv in just before he put me to sleep then it was the nurse who removed it the following morning I think it depends on the doctor and their preference if they want to do it or have their nurses do it
@@maryannkom299 it just depends … as a retired OR RN we worked as a team. There were times when a CRNA was with the patient, the anesthesiologist would look in one arm and I would look in the other arm. Sometimes I would get it sometimes the Dr and sometimes the CRNA would just put in a line in the patient’s neck. It was all about the patient. Leave your egos at the door.
I just use the ultrasound or EJ them
That thing of noticing people with excellent veins occurs to almost everyone who's done a phlebotomy rotation. It was one of the first things my best friend said to me when we first met, that my veins are incredible.
Hi Dr. Max, very very informative and I wish you were my anesthesiologist during my recent surgery. It was okay since I felt very comfortable with my Doctor who had explained so much to me and answered many questions that I had. When I had to make decision I selected surgery to have prostate totally removed and was done with robotic unit. My issue was in preop when they get you ready to roll into the OR. The nurse said she had to be IV in 1 arm and a backup in my other arm in case of emergency so it happened. It took her 3 tries and busted a vein before she did her job. The onto my left arm I was more than nervous if she could do a better job, but instead she excused herself and brought back another nurse to set up this IV and I was very happy. My surgery lasted 3 hours and I was most happy and now waiting these 60 days to be sure it was caught. I will view more of your videos and learn more. Thank you for your personal time and dedication!! I am sure your hospital and OR team are pleased to have you on the team during surgery and hopefully no crawling under the drapes to get toy our patient. God Bless! dwb
He’s back!!! 😊
Today I begin the last year of my seventh decade and have had more surgeries than
politicians have lies. YES please send One Stick Sally or Sam to put in my IV!!!
Amen to that! Oh I hate it when they blow my veins!
@@theoriginaljayz28 Oh Yeah! Before the only really botched surgery
I ever had (Dr Hack N. Slash & crew), the nurse blew !!three!! veins
before getting it right....
OTOH, twice I have had IV insertion with zero pain. Unbelievable!
Both were from an RN.... One Stick Sally!!!
I'm having a Colectomy on Tuesday May the 16th. I have Complicated Sigmond Diverticulitis and a Fistula to my Bladder and my surgeon thinks I probably have Colon Cancer as well. I'm 37 years old and this is my first Major Surgery. Thank you for all of these videos that I have been educating myself a bit on the last few days. Feeling much more relaxed and comfortable going into surgery. Thank you!
I hope your surgery and recovery went well!!!💐
I’m learning medical terminology because I want to work as a Spanish medical interpreter. Thanks because you explained really well and very clearly. 👍
This is a stellar video. 👌 Nothing left out and you made it look effortless. (As a nurse I appreciated the need for the facility shout out for supplies)
There is the video :D
Think that a IV could have so many variables to analyze, make me love even more the anesthesiology.
You are such a great Dr!! You explain everything so well!! It would be awesome to be as smart as you, and to have such a rewarding job! I wish you were here an anesthesiologist here in a Pittsburgh pa hospital. I would definently request you for my surgery!
Retired RN here. Back in the 90's I was a medical supervisor at a large prison here in Texas. Best experience ever. One day we get a call that an inmate was in status epilepticus. He was a muscular guy who could play linebacker for any NFL team. We go pick him up and bring him back to the medical unit. He was seizing big time. I needed to start an IV.... there is no doc 24/7. There was only ONE reasonable location, literally, the external jugular vein. In goes the needle and in goes the Valium 10 mg at a time. Over 45 minutes or so he got probably 60-70 mg before he stopped seizing. You have to remember this a prison. You just can't call ems, they roll to the gate and you toss the guy in for a trip to the hospital. Considering the SE and lack of O2 you do what you have to do. We saved him and he slept like a baby for a day or 2.
A someone who has an er Dr take 7+ tries to get an iv in when my blood pressure was crashing, I deeply appreciate anyone who is skilled in placing iv's or drawing blood
This helps me understand how anesthesia works. I need a hip replacement and have lower back spine issues. 😫 when the time comes I will know what to expect. Wish I could have this doctor. I have never had surgery before. Thank you.
Your videos came up in my recommendations as I was looking for information on hysterectomies (I'm having one in little over a month). I watched a few and I was hooked! My veins are notoriously bad and uncooperative; last time I got an IV it took 13 sticks (including in both my feet, that HURT) and eventually they gave up and gave me a central line (which was so cool, I'm a nerd >.>;;) I'm hoping my veins cooperate for surgery next month. Thank you for all of your informative videos, looking forward to the central line video. Take care, get some rest when you can and have a very nice day :3
Thanks for sharing. I'm most thankful to the anesthesiologist who took my feedback seriously, to avoid wrist joint when setting IV, cause I needed my arms to help me move in bed for prolong period after fractured femur. Felt so sorry that I didn't get to see him / her as I wasn't wearing my specs in OT 😅 Felt sorry for not able to thank the anesthesiologist after I wok up from surgery.
I'm a NICU nurse, and I was laughing at the 24g being tiny. I knew other disciplines think 26g are small, but 24g is our go-to size. We virtually never place anything larger peripherally. But also, we never give fluids anywhere near 22ml/min.
I'm not really a Doctor and don't play one on TV either... but you are a Great Doctor with a very bright future. You 'bedside manners' must be awesome, because your ability to explain complicated concepts in everyday terms is appreciated by your patients.
Hi Max great video. Could you give some pointers on unconventional IV sites for difficult patients or tricks on cannulation for chemotherapy, geriatirc, obese patients.
Hi Samuel, thanks for watching. My go-to spots for the patients you mentioned:
- Chemo: Literally anything I can find. Sometimes have luck with the course of the basilic vein in the forearm.
- Geriatric: Usually AC fossa, sometimes using ultrasound with a longer IV so I can get further down into a deeper/larger vein like the basilic. These veins don't move around as much on me as compared to hand veins in these patients.
- Obese: Hand IVs actually tend to be easy to find.
Max, I’m just a lay guy who likes to watch medical shows such as Chicago MED & Grey’s Anatomy. I’ve listened to all of your videos, and not just because they’re interesting, but you explain things that an average non-medical guy can understand, at least about 98% of it.
Now, when they’re barking out orders on television, and rattling off medication‘s in the ED, I actually understand exactly what’s going on… what those medications do, and why they’re being administered…even if a lot of it is done for dramatic affect.
I have loved watching your series both as an educator for a fictional television show fan, and as a potential future patient… All valuable information and fascinating as well!
Man I hate the sight of IV's or needles, I can't watch during a blood test. Somehow this made it less freaky knowing what's going on.
Facts fight fear.
Wow! Great topic. I often wonder about IV during any procedures particularly surgery. Consideration is a proactive approach particularly is the patient has issues with veins..Such as, rolling, line blowing, and incorrect insertion of IV.
I often wonder if the size of IV is important too. Excellent video and informative.! Stay safe.😁
I have nothing to do with anything medical, I was a teacher for 33 years, but for some reason I find all your videos fascinating. I am supposed to have a hysterectomy due to post menopausal bleeding but here in Ontario, Canada we are under stay at home orders, our ICUs are overrun with COVID-19 patients and who knows when this surgery will happen.
In the past I once had to have a nurse come from the cancer unit to me in Emerg to put my IV in because I needed a blood transfusion for anemia
Left BC here. Finished Chemo October, no port, hard stick, thank God for Ultrasound guided IV. Except once during blood work at a E.R. The Ultrasound tech after she started to jab me stated they do no numb the area first. Wow. I just started watching all your videos you make it very interesting I didn't realize there were so many aspects. Thank you.
My hospital had its own blood bank and occasionally the surgeon decided after the patient got to pre-op holding that she/he wanted the patient to get a type and cross match done. I worked as an RN in the blood bank. I went down to pre-op and since I had to stick the patient for the TCM, I often put in an 18g needle to get the blood sample and flush the needle in the forearm so it could be used by the NA or anes. MD. I always checked to see which side the patient would be getting the procedure done so the IV line wouldn’t be in the surgeons way.
Very informative! As a patient, however, I find IVs in the antecubital fossa hurt the most. And whenever you bend your arm it sets off the alarm on the IV pump.
I did the same recently I was in hospital. Every time I bent my arm, the drip would set off an alarm at 3am.
For me it’s the contrary! The hand was the worst and I never want to do that again.
@@NataliaPessoaXOXOMAKE yess! My hand was terrible, they had to try 5! times. Also, when I was going “to sleep” the anesthesia hurt like hell! The following surgeries I requested an elbow IV, did not hurt at all! Placement did not hurt & going to sleep did not hurt.
FYI: Why needle size goes down while the gage number goes up: It refers to how many times the tube has been drawn. The manufacturer receives a tube of one size, usually the equivalent of a zero gage, and draws it through a series of ever smaller dies till the desired target is reached. How many times this is done is the gage number. So for a #14 needle, or 14 gage, the starting tube has been drawn down 14 times.This is the same for wire and sheet metal.
I'm always so thankful to see the Anesthesiologist prior to any surgery I've undergone, and unfortunately I've had a dozen; but that's what has taught me to appreciate them. I'm pretty zen about everything in the OR, having been a Scrub, except for IV placement. My hands are notorious for infiltration, so though it's more painful, I always ask for cephalic or basilic placement whichever they want. Also, because of my history of resus in surgery, I've always told them to err on the side of higher volume vs. higher gauge. A few have laughed, and a few have looked smugly disbelieving. None have come back later to tell me I was wrong. As far as I'm concerned, the surgeon works for them, not the other way around. It's never been my surgeon trying to reinflate my sticky, damaged asthmatic lungs (nope, never smoked anything but second-hand), deal with my extreme hypoglycemia (my normal glucose level hovers around 65 and I've walked into an OR suite with it at 30 - no lie) from lack of overnight nutrition or quickly insert a central line when God knows what happened due to my venous insufficiency. It's always the anesthesia team. The only thing I wish is that I could be fully conscious but fully numb for everything. There's nothing I haven't seen, heard, or smelled in an OR anyway. My last word: Send me some weird dreams, Doc. I gotta try and take something away from this other than a new scar and a frozen butt".😅
I think your videos are a great patient education tool. Too bad there's usually not enough time before the OR for many to see them.
Very good. It's great the hospital lets you make these videos on site.
As a former RN, I can ABSOLUTELY relate to subconsciously looking at peoples veins and wishing I was starting an IV on some of them. My oldest son has the biggest veins. I could throw a 16 like a dart across the room and get proper placement in his vein smh. I refuse AC IVs (on myself mostly), so Im a pain. They just get kinked too easily, set off the pump and a nurse is never around to silence it. Plus, on the nursing end, nothing worse than being behind, finally sitting down to chart and 2 patients' pumps start beeping. It's very rare another nurse will be willing to fix it for you. But ACs are so easy and strong to start an IV. My veins are so scarred there from SO many IVs.
I’ve had a large bore IV placed awake without numbing medication 🤣 wasn’t fun, but was an emergent situation where access was needed so there wasn’t time to screw around. Usually IV’s and blood draws don’t bother me at all. That one was quite a bit worse but I breathed through it and was fine. Thankfully I have a high tolerance for pain and needles don’t freak me out. Had I been afraid of needles or super sensitive to pain, I could see how someone might hit the floor 🥴
Same when I was awake getting an IO
I'll be applying to anesthesia this fall and I really appreciate your videos. I started watching them when I was on the fence between IM and anesthesia, and here I am :) Do you have any plans on doing a video about intubations? I would love to learn to be better at them!
You will get better at them. Practice, practice, practice. The more you do, the better you will become.
@@sunny71169 Exactly. It is all about experience.
You do great work. Super informative and interesting. I eagerly await your videos. Your passion is inspiring. Keep it up!
I loved your video about placing an IV during surgery. Sometimes my veins are hard to find and they tend to move a lot and they have to be placed in my neck which you didn't mention in this video. You didn't mention that you don't ever place an IV in a patient's neck that's difficult to stick.
You're correct I didn't mention neck IVs -- that's definitely an IV of last resort but it is possible!
Thanks for the post! Honestly! I wish I knew the IV was a flexible tube! I have always thought I had a sharp metal tube in my IV so I feared moving. Now I can know that any discomfort is just the very flexible tubing and not a metal tube cutting through my vein anytime I moved. Thanks!
Gosh my husband's in hospital. A CT showed a 5.6cm AAA . His surgeon seems so caring. They had to do a kidney prep for a different type of ct with a potent contrast . There doing surgery mon as they need his labs better. I PRAY TO GOD he gets a anesthesiologist just like u! 🤗🙏🙏❤
My daughter had to have a surgery while in NICU at 2 months old. She barely weighed 5 pounds so it was scary. Her team was great and her anesthesiologist saved her life. The IV they stated using to put her under was misplaced by the time of surgery and the drugs were injected into her muscle. He noticed right away and was able to compensate and make sure she didn't overdose.
Also, the IV sizes for infants are miniscule! I don't know how the RNs could get them in!
I really appreciate these guys as someone who has had a liver transplant.
Very interesting! as a nurse myself, im concern about the location too, but the concern lies in avoiding joints like AC fossa or wrist, as patients may be mobile and moving. Frequent movement tend to 'kill' the IV access too.
And it can scratch up the inside of the vein - almost 3 years later, one that was placed basically in my wrist (it wasn't done right), the vein is still suffering, and it was only in for about 5 hours (I was awake the entire time that it was in - not surgery).
I have no idea how I got here, but i am enjoying these videos and learning a lot. I’ll be much more informed if I ever have to go under the knife. Thanks for the info and entertainment doc!
Oh my gosh. I’ve had 12 surgeries, 4 spinal surgeries, a double mastectomy with node dissection, I’ve had ENT surgery.... oh my goodness... the list goes on. I have few good veins and he hit on all of them.
Cool stuff man ! I just finished my Anesthesia rotation as an ED resident. Really good experienced, learned a lot of techniques for intubation and also placed some IV's !
Having been on the receiving end of many iv's and anaesthetics this was interesting. I don't have any good veins available and as soon as they blow that vein on the first try I know how it's going to go. I'm happy when they usually decide to use gas and put the iv in when I'm asleep, especially when I wake up and it's in my ankle 😮
So how do you convince them to put you out first???
@@truthBtold-ld5sd it's not my call. They'll try for an IV 2 or 3 times but when they realise how difficult it's going to be they opt for gas. They don't want to cause more pain than they have to. Downside to gas is it makes me sick afterwards and you can taste it for days but at least it's painless lol
Glad to see you are making videos again! I matched for a veterinary anesthesia residency at university of Georgia starting this summer. Hope your residency is going well!
Congratulations, really glad to hear that! Best wishes for residency and please keep me posted on how it goes. I would love to do a vet anesthesia rotation.
@@MaxFeinsteinMD I’m hoping to do a human anesthesia rotation. We will have to coordinate!
Go Dawgs!
My son had a long and complex head surgery, and came out with a cannula in each extremity (hands, feet), in each elbow, in his femoral artery, an artery in his wrist, and they took out a needle in his forehead before he left the OR. He needed two full blood transfusions, and the anaesthetist called for the surgery to end at that point for my son’s safety. It must have been so complex for the anaesthesia team, with so many different components to monitor and manage. I knew in all his subsequent surgeries that the anaesthesia team would take care of him, keep him safe and comfortable, and that was very reassuring.
The most painful iV location is the Wrist! I never again went for a wrist on anyone after I experienced it myself! I rarely get to insert cannulas anymore. working ambulance during Mschool, I did go in with a 24g a few times, sadly!
The last time I had an IV, the nurse who did it had never done one before - she was supposed to do it in the back of my right hand (I'm R-handed, but the veins on the back of my left hand are spidery; I'm fine with blood draws in the AC, but I can't keep my arm straight for very long, so AC is totally out for an IV, and they let me pick where to get it, anyway), but she started it a good 1/2"-3/4" too high, and the pain from the end of the cannula scratching around in the vein at my wrist was enough to make it impossible for me to use that hand at all - almost 3 years later, where it scratched is still slightly sore if I rub it just right. It was so painful getting it put in (I'm sure if it had been done in the correct spot and the correct way, it would have been fine - that nurse had absolutely no idea what she was doing, even though she had an experienced nurse there talking her through it; I get that people have to learn somehow, but I was still very unamused to be the guinea pig in that situation, since they didn't tell me beforehand that it was her first time, and the last time I'd had an IV before that, I was too young to remember it) that the only thing I've had done that hurt more was getting a stubborn wisdom tooth pulled basically without any anesthetic. All that to say, thank you for not doing it in the wrist!!
Nope. For me it's been IO and palm of hand
Great video!
I learned it only recently by asking the question at the hospital while they were placing a catheter on me and I think patients should be explained that the needle of IVs doesn't stay inside! I'm sure many don't know it and psychologically knowing it reduces a lot of the anxiety of IVs I think. My fear used to be that the needle would wreak havoc inside of me if I moved. Once I knew it was only a flexible piece of plastic tubing that stayed I was WAY more at ease with IVs.
Its great for anyone like myself that is interested in medicine and learning how you do your work, very cool stuff, look forward to the next video!
Awesome, thank you!
Thanks so much for explaining all this! I always ask for the IV not to be placed in the top of my hand because it's so painful in that spot. Most of the time they can accommodate me.
You weren't kidding when you said propofol can sting going into your veins. I had one unforgettable experience where it felt like a blowtorch on my arm! I swore like a sailor.
Good to see you again Max!! Great video! I love learning this stuff about anesthesia…I just had a second kidney stone surgery Monday…actually it was scar tissue in my ureter. I will have the stent at least 4 weeks this time so I can heal around the stent. I think it will go well!! Thanks for the info and have a great day!
My experience regarding placing an IV in the hand. Since I have very large, easily accessible veins, when I had an IV placed in my hand, it actually caused irritation when I was using my hand for basic things like using my phone or laptop while I was recovering from surgery, which, after not too long, also lead to a bit of bleeding because of the tugging and snagging. I had to ask the nurse to move it further up my arm because of this.
You are taking my mind to another level
Pain from IV insertion in the hand can be completely eliminated by injecting a very small amount of local anesthetic with a very small bore, 28-30 gauge, needle, prior to insertion of the IV.
ER nurses need to be told this. Every single one of them!
In the chain of mega hospitals in my area, the lidocaine pretreatment is only used for larger sizes, not the typical IV.
You would think they'd want to do it every time so as to bill me for it. Since they don't, it can only mean that most insurances don't cover it. But why would the insurance company deny $4.26 for lidocaine but pay 100% for an ultrasound vein finder?
Will you do an intubation considerations and a ventilator 101 video? 🙏😸
Retired OB nurse. We cared for a lot of high risk patients. Our anesthesia head wanted us to use minimum of an 18g, whenever possible. Those OB cases can change gears very quickly.
I’m a hard stick, but the best advice I’ve ever gotten is to truly relax and mean it! I’ve had people flippantly tell me to relax, and three sticks later, we finally have an IV. I once had a nurse approach, recognize my fears, and then speak softly, calmly and got me to relax completely before inserting the IV… on the first stick. Pre-op areas are often noisy and busy, which does not help us to relax.
A nurse or doctor who is calm and has a soothing voice makes all the difference. I HATE needles but can usually breathe through it. I appreciate the good nurses so much.
It is a very nice service Max provides as a resident. Once he is no longer in training he will have little free time to do so.
Thank you doc. I've had a couple surgeries and met the anesthesiologist prior to surgery but you never know what questions to ask. So it would be nice to ask what the plan is going into surgery and know what the doctor is talking about. Keep up the good work and thank you again.
This was such a great explanation. I know now why I have to sit in the infusion chair all day for my immunosuppressive treatment every month.
I’m curious would you ever give anesthesia through a port? I’ve had mine for over a decade and I’ve always been curious about that!
You gave me a lot of info that I had questions about. I still do have some questions so will continue to view your great videos, and see if you have answered them.
I absolutely love ur vids! Ur hospital must be really supportive of u making these vids that’s awesome! Btw when would u use that huge Iv? Maby a trauma case where they need a large volume really fast. Take care bud.
Thanks Mike, yes the hospital and especially the Mt. Sinai Anesthesiology dept are very supportive. Big IVs like that for trauma, big orthopedic or neurosurgeries, some OB surgery, liver transplant, sepsis -- just some examples that come to mind.
I had to have a couple 14G needles for trauma surgery due to a motorcycle accident (broke my ribs which lacerated the splenic artery ). They were pushing fluids like crazy (fortunately I was able to use a cell saver during surgery....but they had 6 pints of blood if needed). My hat's off to my anesthesiologist....he had to hurry...he was intubating me while putting me out and never skipped a beat....great trauma team.
Your videos are very informative and helpful 😊 thank you, I have really learnt a lot from them.
Really interesting and extremely well executive video. Best I have ever seen. Great job.
Hats off to anyone who has been able to get anything above a 22 in me! I am a PICC/ central regular
11:35 Love the telephone in the background 😊
Thank you very much for the video!! I learn a lot from your videos,they are very interesting to me and well explained too 😊🙏
I am truly enjoying your videos. Very educational. I am retired from business but have always been interested in any thing medical. THANK YOU!
I'm a former health professional who was licensed to give injections and start IVs. Thanks for this informative update!
This reminds me of one time I was in the ER. I was in the ER due to tachycardia (ended up being due to dehydration), so they placed the line and took me to imaging. They took me in for CT with contrast (which I had to document as an allergy because of how severe my nausea is after it processes), and hooked me up for it. After that, I was given a bag of saline and sat and waited… and waited… and waited… I asked the attending when I could be discharged and they said after I finished the bag. When they came in to remove the cath, they realized they had been using the contrast dye stuff which is much smaller gauge. They apologized because while it didn’t have any clinical contraindications in the end, it meant it took longer to rehydrate, which meant longer ER stay.
I've been told by nurses and doctors on multiple occasions that I apparently have beautiful veins 😄
Pro-side: So far, no one has ever missed a vein when drawing blood or placing a line.
Con-side: I've been asked multiple times whether it's okay if the new trainee places the line since apparently my veins are hard to miss
Great video man! I learned a lot about Anesthesiologist, I tried to go to college to be a Anesthesiologist but it was gonna be too hard because of my cerebral palsy! Keep up the great work
love all your videos. I am too old now, retired but had wanted to be an anesthesiologist if I could have gone to medical school. I did get into radiology, at the time I went to school it was free in the hospital but we also worked in radiology some 40 hours each week. No such program around today.
I'm an older dentist that offers outpatient IV sedation. I stumbled across your channel some time ago, became intrigued and have now watched most of your journey through residency. [1] Quick question regarding lymph node dissection. I never place an IV on the same side as my auto-BP. Consequently, for patients that have undergone lymph node dissection, I usually place the IV on the side of the dissection to avoid the need to take BPs on that side. Bear in mind, (in contrast to your needs) I'm dealing with extremely small volumes of fluid. For extended dental cases I want barely enough fluid to keep the line patent. Otherwise, in a 3-hour case the patient will show signs of needing to urinate. (LOL) Your thoughts about IV and BP placement? [2] I thought I was the only person that walked around looking at people and thinking, "Yeah, that's an easy placement." or "Wow, I hope I'm not doing one on them."
Thanks for following along with my videos! Great question-- in the scenario you describe, I would probably opt to put the IV and BP cuff on the same arm, Since you said the IV is running a minimal amount of fluid (and I'm assuming few/no other medications) it sounds like it wouldn't be detrimental to have it occluded once every 3-5 minutes. Having said that, the risk of lymphedema is so low that your approach sounds reasonable as well.
One thing I think some people in the medical field don't always consider is patient input. A 23 gauge can be used to draw blood from my hand, once; it always blows the vessel. My right AC pops out more than the left but the left is more patent. PICC lines for me are better on the left because of damage on the right from a previous PICC. Fishing will make me vomit and pass out. I've never had an IV in the forearm that they could get first or second stick. The only one I've had was placed while I was under. I feel that if the patient can tell you those types of things that their input should be considered. Also, replacing catheters that are patent in a long-term hospitalization just sucks. Both hands and left AC blew out and so did both basilic veins and they wanted to replace a patent 20 gauge in the left arm and spent 15-20 minutes with a vein scanner and decided to just leave it.