A VERY COOL TOOL FOR CENTRAL LINE PLACEMENT
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- Опубліковано 8 лют 2020
- A VERY COOL TOOL FOR CENTRAL LINE PLACEMENT // There's something in your central line kit that you may not have to noticed befe and it's a GAME CHANGER. It's a needle with catheter will change the game in how you place central lines. Watch this video and learn about this awesome little tool.
Have you used this magical piece of central line equipment? Let me know in the comments section below. If you enjoyed the video please give us a like and if you want to see more, please subscribe so you never miss any great content.
Stay awesome
Also like it for troubleshooting when your wire hits resistance. Really easy to re-confirm good blood return so that you can re-attempt to place your wire without doing a 2nd stick.
Yes! Thanks for your comment
Also great in the case of a crashing patient that doesn't have peripheral access. You can use that catheter to administer code meds mid-procedure, and then proceed with inserting the definitive central line without having to regain access to the vessel. Great video.
Halfdan Bau-Madsen That’s an awesome tip! Thanks for commenting. Do you get any more of your own?
@@CriticalCareNow Nothing that comes to mind immediately, but I'll be watching your content and happy to share in the event that something does.
Halfdan Bau-Madsen Awesome! Appreciate your comments and looking forward to more
This channel is so underratedd
I appreciate that so much
thank you for your thoughts about teaching novice trainees in this field. I agree that the lack of motor skills is likely to fail the steel needle technique.
Thanks for your comment and insight
I usually use the steel introducer needle. Tried the angiocath yesterday. I was able to thread the angiocath into IJ. I don’t know what happened but I was not able to threadthe guide after that. For some reason the angiocath kinked in the soft tissue and it was very positional if I straightened it out slightly blood would flow otherwise it wouldn’t. I tried couple of times and then just took it out and did it with the regular way. Has this happened to you and any tips for avoiding it?
I had difficulty visualizing the angiocath under ultrasound.that was why I had abandoned it. Worked well for me with the landmark technique prior. Looking forward to your video demonstrating its use under ultrasound guidance.
You should be seeing the needle and wire with ultrasound. I highly encourage the in plane method for the angiocath
I second that. Plus on the first pass at least, the little bit of air between the catheter and the needle seems to add to its echogenicity@@CriticalCareNow
In the infrequent case that you get the angiocath into the vein but for some reason (usually an anatomic anomaly) you cant get the wire in deep enough to place the TLC, you can secure this and at least have SOME access in the meantime while working on more definitive access.
100% agree!
I like to place it over the guidewire and then remove the guidewire. Then I hook it up to an arterial line tubing to make sure it is not pulsatile ( and not in the carotid artery).
Nice. Thanks for commenting
I do that too! I find it easier to use the regular needle, feed the wire, then use this angiocath over the wire to confirm placement with pressure tubing and proceed as usual, yes it takes an extra 10 seconds but you save a potential vascular surg. call at 4 am...
Thanks for commenting!
I found it useful in US guided IV.
Perfect. Thanks
We can use that to confirm placement. Vein versus artery especially in hypoxic and hypotensive patient where you might not get bright red color blood with pulsatility.
Great point. Thanks
I was trained to have a small coil of tubing that could connect to the angiocath, drop the other end, it fills, raise it up, it goes back in, you are VENOUS! As farhanquadeer mentions, if it is bright red, pulses, or climbs when tip raised above patient, it's arterial. My first central line in practice, this saved me, as I stuck the artery, and knew to come out and apply pressure while moving to another site to obtain central access in a crashing patient.
I am missing this guy here in Colombia. the kit doesn't have it. I was trained in Canada with this one.
It’s a really great tool.
Multiple pluses/uses:
-If you need to get a case going and the wire just doesn't want to advance due to some stenosis, but you clearly have forward flow on doppler, you can get the case going with the 18ga cath. Then futz with the CVC later.
-If you used the introducer needle initially, but again the wire won't advance easily, exchange the needle for the catheter over the wire. Slide the catheter in completely, then pull the wire "J" into the catheter and readvance the wire. Most of the time the wire will pass the obstruction.
-Not sure if you're in a vein or artery (e.g. sickle cell patients have bright red venous blood), attach an IV extension tubing (~40cm), pull back a few cm's of blood and hold up the tubing. Called tube manometry. If it is squirting off the walls and ceiling it's an artery. If it is
Do you hub the cath, remove the needle, and then advance the wire through the cath alone?
Kind works like a peripheral iv catheter
I have never figured out what they are for..thanks a lot...
Happy to help
Great video and tip. But do you have any experience in Syringeless CVC Placement?
Yes, tends to fail with patients who are volume down
Nice
Do you have any experience using the EKG saline conduction method to confirm central venous catheter tip location?
I don’t. Please tell me more
Do you have a video of how to place it?
One coming soon
I believe this is a smaller guage needle than the steel harpoon, SO, IF you were to tap the artery, less damage has been done, and hemorrhage would presumptively be less. Note: I trained before the advent of U/S so my early experiences with this catheter were predicated upon a landmark technique approach.
Agreed.
I usually use the steel introducer needle. Tried the angiocath yesterday. I was able to thread the angiocath into IJ. I don’t know what happened but I was not able to threadthe guide after that. For some reason the angiocath kinked in the soft tissue and it was very positional if I straightened it out slightly blood would flow otherwise it wouldn’t. I tried couple of times and then just took it out and did it with the regular way. Has this happened to you and any tips for avoiding it?