TECHNIQUE OF SUBCLAVIAN LINE AND TRIPLE LUMEN CATHETER INSERTION WITH ULTRASOUND GUIDANCE
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- เผยแพร่เมื่อ 7 ก.พ. 2023
- By request of NYSORA’s TH-cam channel subscribers Dr Hadzic explains the technique of Ultrasound- guided subclavian vein cannulation. In the video, he describes step by step how to identify the subclavian vein and insert the triple lumen catheter under ultrasound guidance. The video also features a new, very practical EZCOVER®, Universal Procedure Drape (info@medxpresspro.com) and EZCOVER®
Ultrasound probe covers with second-skin like material and a safety STOP before you BLOCK barrier (www.bbraun.com/en/products/b2....
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I was looking forward for this video from this channel but this was just an advertisement. I will wait for a more detailed one for this fantastic topic.
Allright! Thank you
I think the out of plane technique is superior because you have constant visualization of the artery and vein to avoid accidental punture of the artery. I know is a short video but I think you should always check the IJV after advancing the guidewire with the US probe to avoid ascending catheter placement. Excellent video as always!
I find the in plane technique superior as the need is in view all the time all through its course till it reaches the target vein.
With the right angle and depth, you can get the vein and the artery on the same image in the in plane approach. For instance, at 5:52, you can see the artery beneath the vein. It is absolutely possible to align the 2 vessels and avoid a puncture of the artery!
I totally agree with checking IJV to ensure guidewire is not there and I d like to add it s also a good idea to check contralateral subclavian vein, especially if you use 20 cm long catheters. If you dont want to measure CVP or ScvO2, it is not a big problem having a catheter going though one subclavian to another but if you do want to measure them, I reccommend checking ipsilateral IJV and contralateral subclavian.
Seemed most of all as a commercial for the drape and cover. Otherwise great as an instruction video except I would not recommend pushing in the dilator with the guide. Instead use the guide wire as intended to avoid kinking and inadvertent puncture of vessel wall ie. hold the guide and advance dilator
Abrazos Andrés. Gustavo Castellano.
Hi everyone! I would add to the educational part of the video a mention about the usefulness of checking the guidewire position inside the vein with the US probe to make sure it is really in there, before attempting to dilate especially when a large bore catheter is planned for placement (dyalisis one for example). Sometimes tactile feeling of absense of a resistance to the guidewire threading is deceptive and you may cause harm to the patient proceeding with a large dilator without a confirmation.
Absolutely correct! Всегда контролирую где стоит проводник перед бужированием
Another great video Dr Hadzic! Now we must of course have the follow up video, Dr Hadzic shows the youngsters how the god of cannulation does central lines with landmark technique only just like the good old days 🤣🤣🤣Even in first world countries sometimes you don't have a ultrasound probe nearby (cough UK NHS cough)
Allright! That sounds like a deal. Will do. Greetings and thanks for watching!
Nice video,
I request that it would have been much better to add landmark and sonoanatomy part to indentify before going for subclavian cannulation. Plenty of us are anxious for subclavian cannulation due to artery deep seated, risk of pneumothorax.
I really appreciate the efforts you put in to satisfy demand of all subscribers.
Dr. Hadzic always with the best explanations, thank you
Great video , i have been waiting for this explanation ❤️
Thanks for helping folks during the AIDS epidemic!
Perfect example with nice tips and points. Thank you so much!
Thank you Alptekin! Greetings and thanks fo watching
Nice video, Dr. Hadzic. I think that the wire comes through out the distal lumen not the proximal one. But it's a small detail. Best regards and thanks a lot.
Great video with precise explanation like always👏👏
Great feedback. Thank you
I exclusively do my all my catheters US guided, including the subclavians, but out-of-plane, simply placing the transducer parallel to the clavicle. It's sometimes difficult to image the vessels bc in ICU or crit care patients with hypovolemia, even the subclavian vein can collapse on the patients inspiration. I found it easier to do it out-of-plane and to ident art./vein that way, although you generally have to point the needle at a more perpendicular anlge towards the vein to intersect your ultrasound plane easier. This however can increase the risk of pleural puncture in obese patients with/or in case of low quality imaging, though the 2nd rib might shield the pleura at that position.
Anyway, nice in-plane demonstration and it's very smart to do a time-out before procedure. We have a general sign-in procedure when the patient arrives in pre-OP, so it's similar. Highly recommended something like that for your own safety!
S/H. Great technique, as well. Greetings and thanks for sharing and watching
Salutations 😌🙏
great explanation! thank you Dr. Hadzic!🎉
Great feedback. Will do! Thank you
Can you please post a video with the landmark technique you use
Hi Marius. WIll do
Great video, thanks for explanation, very useful and precise!
Thanks alot
God bless you
You are welcome Nadia!
Thanks Dr. Hadzic! I had thought the CLABSI bundle called for a full-body drape. At least for catheters that are both inserted and used in the ICU and for catheters inserted in the OR and used in the ICU.
Hi there. I gues the protocols vary among institutions. However, the EZCOVER in the video here is rather large and in my opinion, sufficient. Greetings and thanks fo watching
Wow 👍
Nice ! On point I want to add here , when we introduce guide wire we push it not more than 20 cm , if it touches the endocardium could cause arrhythmia.
Dude made it look so easy! If only most SCVs were that easily and clearly seen via US... Still, amazing video!
Glad you enjoyed it!
Thank you Dr.Hadzic for a detailed explanation. Enjoyed it. I am a junior ICU registrar in India about to do a CVC audit. I liked the fact that you mentioned about the ventilator adjustments prior to a cannulation. I don’t remember doing it usually. Will include the point in my audit format. I am sure it’s gonna give away a lot of mistake by registrars 😂 Again, thank you very much ❤
Thank you so much for your kind comment. We are happy you found this useful. Have you subscribed to our newsletter for more educational content? www.nysora.com/newsletter/
Great video. The sound effect spoil it a bit.
I have to agree with the sound effect. Thank you for the comment! Greetings and thanks for watching!
For a CHEMOPORT insertion into the subclavian, we can't quite have the needle entry point so close to the clavicle and it is about 3 or so cms below the clavicle. How do we go about it in that case?
Nice.
I would like to hear something about peripherally inserted central catheters (PICC). I would like, after knowing your opinions, to compare them with my experience. Thank you.
Great suggestion!
This is more an ad for that ez cover drape than an instructional video :)
Hi there, thanks for the comment. Why do you think so and how would you do it?
good afternoon dr Hadzic. I have had good results abducting the patient's arm for subclavian access instead of keeping it close to the body. the vision of the vein is much better.
Great to hear! Thank you for sharing and Thank you for watching.
Thanks for sharing , from a surgeon in a rural trauma hospital in India 👍🙂👏
Hi Pravin, Glad you are enjoying the content. Appreciate your feedback!
Greetings my dear Dr. Hadzic, very good video. I dare to make some comments. I like it and I find it very practical to use that transparent field. The use of ultrasound seems better to me than using anatomical references, even more so in patients with volume depletion where the veins tend to collapse and it is easy to penetrate the subclavian artery. There are also anatomical variants that can be better appreciated by echo. Regarding the execution in particular, I think it is safer to perform the visualization in the short axis to identify the vessels well, and then perform the puncture well in that same axis (particularly it is my preference), or rotating the probe to the long axis to perform the puncture. Also use both color and pulsed Doppler to safely identify vessels. Of course go as lateral as possible to avoid the pleural dome and avoid the thoracic duct (on that left side). Of course never losing the tip of the needle is very important. Thanks for the video, excellent. Greetings
Hi GC! Thank you for sharing! Greetings!
How is this steril cover for the patient called? Can‘t find it in the BBraun product catalog.
We would like to try it out in our Anesthesia Department.
The probe cover is „EZCover“.
Again the Question @Nysora how is it called?
What is the name of the Ecover/bbraun drape? Is it available in Belgium? As always, great video!
Hi Wouter. Yes, it is EZCOVER. www.bbraun.com/en/products/b2/ezcover.html. Your local rep should have the info. Greetings and thanks for watching!
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Hello dear doctor Hadzic,can you show please this method of canulation with out USG, because in our hospital we don't have USG in nearest of our reanimation department ,and we are never did with device.Thanks
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Excellent video. Is there a possibility that the catheter is directed to the right subclavian vein?
Would like to see more extensive presentation of US techniques for visualization of SV with In- and Out-of-plane approach, views of the SA and pleura, examples of US picture for obese pts, etc. Would deeply appreciate that! Amazing presentation of the drape and the probe cover though!
Hi Alex, Great idea! Greetings from NYSORA!
What to do do if blood comes from only 2 ports, not from the third?
Hi Vivek. 1) Flush each port before inserting - to assure patency 2) If no flush after insertion - remove-reinsert 1-2 cm to rule out obstruction by positioning 3) If it remains obstructed - use a 3 ml syringe with saline and attempt to flush (controversial due to the risk of dislodging a clot form the port's opening - which may be the cause of the problem). Greetings
@@AdmirHadzic-gp8jf thank you very much
Why did he use a subclavian instead of internal Jugular? In America it seems rare to do subclavian access
Hi Eman. IJ is a go-to access for most indications. However, we received many requests for subclavian vein cannulation on this channel . The ease of catheter maintenance, and convenience for patients and longer indwelling time make the subclavian more suitable for some indications. Greetings
During our residency, sub-clavian was the cannulation place of choice. In ICU of course, for surgery and shirt term use ijv was preferred
From what I've seen, many surgeons or surgical residents will do a subclavian and most medical docs will do right IJ. Just personal preference and who trained you I guess. Personally, I think subclavian central lines are easier to keep clean.
better to know both techniques, since in trauma patient's with cervical collar or in limited area of severe burns patient, subclavian may be a preferable alternative as compared to the IJV
I don't like that you did not visualize the artery and the vein in the in plane technique. Can you see the artery in the in plane technique? We use a Biopatch to decrease the incidence of Central line infection in the dressing. Also, instead of using the steele needle I use an 18 gauge angiocath and thread the guidewire through the catheter so a steel needle does not risk any movement and dislodgement.
Nice technique as well. The artery was indeed identified before starting the procedure, but it indeed does not show in the video thereafter. Thank you for the comment! Greetings and thanks for watching!
Nicely done..but those thud sounds in between are very disturbing .
The sound effects are way too loud, otherwise thanks again for the content
Great feedback. Will do! Thank you
Technically that Is an axillary vein...anyway good the same as subclavian vein.
Too much AD... 😅
Makes video about central subclavian vein cannulation. Proceeds to only talk about the drape for 8 minutes. I usually like your videos but this one was a cheap money grab.
Hi Bennet. That is not nice, as there is educational value in this video on multiple levels. Visited your channel to see if we could use an example of how to improve upon based on the critique, but did not see any good examples (th-cam.com/channels/FCNR1QrB-FFipNEbLSSthg.html). Is it fair to say that it is easier to criticize than create? Greetings
@@nysoravideo Sorry had to be blunt here. This is a promotional video for a product from a private company and should be labeled as such. The title is completely and purposely misleading. I really like your channel and I've learned a lot from your videos, which is why I even bother to write this comment. This is below your standard or at least thats what I thought.
Excellent video! I, too, learned to insert SCV CVCs via landmark technique, and still do so today since I’m more comfortable this way. I use USG for other major vessel cannulation. I like that you mentioned the temporary ventilator adjustments to avoid increasing the risk of iatrogenic pneumothorax. In my practice, if there’s a chest tube in already, I’ll place the CVC on the same side, especially if I expect difficulties or the patient is already on high support settings in the ICU. If I accidentally cause a pneumothorax, the chest tube is already there. Secondly, I tend to also prepare the same side of the neck, in case SCV cannulation is abandoned (I personally stop after 3 attempts to not cause pneumothorax) and need to go to IJV. This has to be weighed with the type of surgery/patient you’re dealing with, since the cannula might be in the way of a neurosurgical or vascular surgeon’s field. Thirdly, when it comes to passing the guide wire, I try to match the curvature of the wire with that of the expected path of the vessel to avoid IJV or contralateral SCV cannulation. Weird things happen! Finally, after dressings are applied, I quickly do a lung scan while the linear probe is still available to check for lung sliding and to ensure no pneumothorax.
This video was very informative and actually draping is pretty important too, if not the most. Dr. Hadzic's videos are helping students and professionals all around the world and we should be thankful for every bit of information we get, rather than criticizing.
@@StephenBudhu Great feedback. Thank you