Take your IV skills to the next level and make a lasting impact on your professional life and patient care. Get your copy of the NYSORA’s Manual on Difficult IV Access today and be the change you wish to see in your medical practice! community.nysora.com/IVAccessManualYT
I’ve been a lab tech for over 30 years now, I have two words for you, heat pack. I realize it sounds incredibly simplistic, but believe me it works. I hate using ultrasound, because as the video mentions, it takes time to set up, and can be very cumbersome, and if you’re in an emergency situation, you don’t have time for that, you just have to find a vein as quick as you can, and when all other methods fail, heat will almost always bring the vein close enough to the surface that you can see the outline. In my three decade career I have never once failed to find a vein in anyone, no matter how big they are. I don’t work in the OR, I work in the lab, but I do get called to the OR a lot, and they can’t find a vein and it’s an emergency. Every time I just bring up my heat pack, looks like a beanbag pop in the microwave for a couple of minutes, I usually bring two or three with me, place them on areas of the patient’s body where you know the vein is, and I guarantee you will be able to find at least one, even if it takes a few pokes, you’ll find it. My professor taught me that over 30 years ago, and out of the countless thousands of patients I’ve had, I have never once failed. So many people think complex technological solutions are the only way to go, I guess I’m just too old-school, but if it works, don’t fix it.
Yes, i totally do agree. That always works. I had to tell the nursing when my dad almost dad and he needed thisIv put in and they had problems and all happened so quickly. I remembered from working at hospital , 9 I heard it said often and used from time to time) and said 'Please get a heat pack, stat.. please" I could not stand it ,as it was dad, and so they found it worked! It was good, I happened to be right there . No one needs to go through it if they know it, and if not, they will be a mess later. Much easier to try a heat pack, and then go further if necessary.
I am an incredibly hard stick. The record is 23 attempts to establish one IV line. I will Never forget watching this video. You have potentially saved my life. I am on a weight loss journey. I was 425 lbs. and now I’m 378 lbs. My goal is to be 280 by next year. Wish me luck and thank you so very much for this wonderful knowledge!
Greetings! And thanks for watching. Do subscribe to this channel as there's more coming up. And let's share the collective experience so that we all get better in what we do!
I was a CRNI and PICC certified instructor. I taught my nurses to never use sight to pick the vein. My choice would be a cephaliac or basiliac vein isolated by palpation only. It is imperitive all IV certified nurses know vein anatomy -especially the upper extremities. Both cephalic and basiliac veins tend to be straight, and have large lumens - just as tree twigs, small branches to large branches venous anatomy is very similar. Veins are always bigger in the upper arm than the distal arm and distal arm larger than hand. Observe the posterior hand veins to learn the patients particular size. Then gauge depth by feeling the bounce of the filled vein 1-2 full minutes after tourniquet placement. A bp cuff might be gentler. Observe the skin condition and ask history of diabetes or other conditions such as chronic steroids that may alter tissue integrity and fragility. Remember use your sense of touch, not your vision.
this is why I worked as a phlebotomist, we have drawn blood from peoples upper chest area so many times in obese pts. This just helps when eventually I'm in nursing school to put IV in obese pts.
Nice work, a real smooth solution, offering much less risks compared to central venous access, although you have to see the vein and probably can't enlarge the vein with a tourniquet at this section, unfortunately.
I definitely use that vein with obese pts in the ED. It’s heaven’s way of tellin me I’ll get thru my shift just fine 😌. Still, ultrasound guidance in a pinch (code and/or trauma) is also definitely an option (basilic v. just before it branches and and becomes the median cubical v.) As the doc said tho, you need to be well experienced with the machine. No problem with obese patients over here in MD, USA. Good to know that as a tech I’m following the same practice as the docs.
It saved my day too, I kept a very obese patient with a 20G catheter near her deltoid muscle. I’m not proud of it but I’m happy it worked. I have extensive education and experience in point of care ultrasound in anesthesiology: head to toe I use it for every procedure. Though I’d like ultrasound to be the game changer, when the path of peripheral catheter is chosen (vs CVC) it just slows everything down. Congrats on your vid! 👍
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Gracias doctor por la sugerencia. Nunca se me hubiera ocurrido. Por allí le estan dejando respuestas espantados acerca que si le pica un pulmón o que si se le infiltra la vía y no se puede ver, comentarios basados en opiniones más que en evidencia.
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Can you give Vassopressors in that superficial vein? Medicine Team says "yes" but Anesthesia team "RIP such vein" ... Good video tbh and next time, try basilic vein in the mid arm with good abduction.... USGIV for deep veins is an art... I would go up to find it, and with a good US even forearm veins are visible and can be cannulated... I was a preceptor of USGIVs for 5 years and I know this business! Never underestimate cephalic veins in Obese patients - Good one Dr. Hadicz
Amazing thank you for your content, whilst at my Internal medicine internship I struggled with a patient that resembled your case presentation patient, we end up choosing a central venous catheter, (which happen to be ultrasound guided), as it was much more stable, and fortunately it wasnt under any hypotensive nor surgical scenario.
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Another reason why vascular access should be planned and not treated as a step child. To even start surgery on an obese pt. with one IV is poor planning.
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That is really great. Thank you for sharing. We all get better this way. Make sure you subscribe to this channel; a lot more is coming soon! Greetings!
In intraosseous access is an option in in adults too, similarly placing a second cannula post induction (and venodilation) in advance can ensure continuity of venous access. I would fully support looking everywhere for a vein, should additional cannulation be required in this case though I personally would have put a tourniquet around the shoulder to improve the chances of cannulation - why make things more difficult?
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You can do IO on adults as well now, with the EZ IO drill. Chest veins SHOULD BE AVOIDED unless it's an absolute emergency, and in that case you should just put an IO in. Chest IVs are very risky, especially in females, if you have a bad infiltrate it can lead to the loss of chest tissue, including breast tissue, thus this area should be avoided. I work on a vascular access team and many of the nurses can't even tell when a peripheral IV in an extremity is infiltrated, never mind one placed in the chest area, and this includes ICU nurses who would be hanging pressers. That is also an area that is going to be tough to tell when it infiltrates, even with an experienced person assessing it! Overall not recommended and not a good idea.
I agree chest placements are bad and ridiculous, but an IO would seem extreme if you can’t get basic access. Go to ultrasound with an advanced peripheral or a mid. ie. rep that sells IV’s, mid’s, PICC’s, cvc, acute dialysis and IO’s
@@calebh4442 IOs certainly are extreme on an urgent but not necessarily emergency situation. There are also various contraindications to them that obese patients are more likely to have such as absent landmarks or cellulitis.
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Thank you for saying that! I was just thinking the same thing. I made a comment live to a TV show where for weeks, it was as if dark skinned people do not get meningitis, as the only symptoms they spoke about or examples featured Caucasian people. Maybe as in your comment, just drill an IO in and let the patient suffer that pain not to mention the agony of the infusion, just because landmarks, examples of working with darker skin were not promoted, shown, or whatever else
Very interesting - I think that just goes to show that the "tradition" of using the most common areas for IV access can sometimes be a bit of a trap, especially in potential emergency situations like these. One small nitpick - I think I saw the needle being pushed back into the catheter after you checked for bloodflow. That seems risky - if we need to prevent unnecessary spillage between removing the leading needle and attaching an IV bag, we just block the vein with a finger, just below where the catheter ends. It can be a bit awkward, yes, but you at least don't run the risk of injuring the catheter.
HI Lukas! Thank you for sharing. Indeed, we all do things differently; in the end - it is what works 4 you. Thank you for watching and do subscribe to the channel - we have a lot more coming up
Problem with these is that i find they tend to rupture pretty easily after a while. They are good for rescue, but not that reliable.. in my own humble experience
*you really felt it neccesary to point out the most difficult IV or V pts youve ever had: AND call them fat?* bc i support that. more of these vids! \^_^/! -JC
Sir, do you think these shoulder cephalic vein tributaries are good for long standing ICU patients? In our ICU sometimes we struggle for IV sites, and also avoid central lines for infection prevention.
Hear me out! I have a theory! Could it work to spray some nitrolingual spray on the skin, to make the vein dilate, and make it easier to hit? I havent been able to test this properly! Has anyone else ever thought about this?
4:47 - nice superficial vein there :) Just above the brachial a. Provided US is available, and it generally is, I find distal arm easier to access than shoulder.
One of the biggest concerns with an IV catheter placed in the chest is the delayed recognition of infiltration. Infiltration in the upper chest cannot be detected as easily as it would be with a more peripheral line. Also, the use of an IV catheter that is intended for peripheral veins could violate hospital policy as the catheters are only manufactured for veins in defined limbs. Please be sure to remove the line in PACU upon the return of more peripheral venous prospects to protect your patient and your license.
This is supposed to be for an emergency in the middle of a surgical procedure. Not for primary site beforehand. It is close to a last resort in a difficult, obese patient.
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Thats a great tip Prof, can you please tell us about the action of muscle relaxant that was injected inadvertently in a cannula that happened to be malfunctioning Does that extavasated muscle relaxant or other anesthesia medication contribute to delayed absorption and its consequences delaying the recovery
Indeed in this scenario the muscle relaxant can linger subcutaneously or repetitive initially and be slowly absorbed systemically and possibly create problems.
You are using a Proseal Mask without a gastric tube in this very obese patient? Quite dangerous, this patients risk for aspiration seems quite high, so the „non-use“ is a personal mystery for me. Can you explain it to me why did the general anaesthesia without it?
Hi there. Thank you for the valid comment. Indeed, higher generation supraglottic airway with aspiration port would have been a better choice. Sometimes the choices are made based on what you currently have, patient's airway and/or specific surgery, and individual practitioners preferences/experience. In this case - the surgery was on the distal lower extremity. Some colleagues would routinely opted for endotracheal intubation and a gastric tube. For short distal extremity surgery, I would personally opt for 2nd or higher generation LMA and slight chest-up positioning, rather than the endotracheal intubation and muscle relaxants. Again - thank you for the comment and thanks for watching.
@@DRBLUESNYC In this case you did use a second generation larynx mask indeed, but the port for the gastric tube is empty, if my eyes are right. Look at 6:42-7:00min from the video behind your head. But only a question, I like your videos very much. Also I improved my techniques for Regional Anaesthesia a lot from your vids and app. So thanks a lot!
@@ghosti8691 Sharp eye! Again, thanks for your comments and the accolade. Admittedly, with the focus on the IV, we have de-focussed on other important elements of this case that I do not have much additional details on. So, thanks for bringing it up.
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Take your IV skills to the next level and make a lasting impact on your professional life and patient care. Get your copy of the NYSORA’s Manual on Difficult IV Access today and be the change you wish to see in your medical practice! community.nysora.com/IVAccessManualYT
I’ve been a lab tech for over 30 years now, I have two words for you, heat pack. I realize it sounds incredibly simplistic, but believe me it works. I hate using ultrasound, because as the video mentions, it takes time to set up, and can be very cumbersome, and if you’re in an emergency situation, you don’t have time for that, you just have to find a vein as quick as you can, and when all other methods fail, heat will almost always bring the vein close enough to the surface that you can see the outline. In my three decade career I have never once failed to find a vein in anyone, no matter how big they are. I don’t work in the OR, I work in the lab, but I do get called to the OR a lot, and they can’t find a vein and it’s an emergency. Every time I just bring up my heat pack, looks like a beanbag pop in the microwave for a couple of minutes, I usually bring two or three with me, place them on areas of the patient’s body where you know the vein is, and I guarantee you will be able to find at least one, even if it takes a few pokes, you’ll find it. My professor taught me that over 30 years ago, and out of the countless thousands of patients I’ve had, I have never once failed. So many people think complex technological solutions are the only way to go, I guess I’m just too old-school, but if it works, don’t fix it.
I will be using this!
Does this apply for finding a vein when drawing blood as well?
@@b.freeman2118 Yes
Potresti dirmi di che cosa è fatto impacco termico e dove esattamente lo posizioni? Grazie 😊
Yes, i totally do agree. That always works. I had to tell the nursing when my dad almost dad and he needed thisIv put in and they had problems and all happened so quickly. I remembered from working at hospital , 9 I heard it said often and used from time to time) and said 'Please get a heat pack, stat.. please" I could not stand it ,as it was dad, and so they found it worked! It was good, I happened to be right there . No one needs to go through it if they know it, and if not, they will be a mess later. Much easier to try a heat pack, and then go further if necessary.
I am an incredibly hard stick. The record is 23 attempts to establish one IV line. I will Never forget watching this video. You have potentially saved my life. I am on a weight loss journey. I was 425 lbs. and now I’m 378 lbs. My goal is to be 280 by next year. Wish me luck and thank you so very much for this wonderful knowledge!
Good luck!! Been on CZcams for 15 years and I’ve never replied to a comment. You’re the first. You can do it!
Congrats on your weight loss!
That’s amazing progress. I wish you luck and good health.
Keep it up Clairity! Thank you for watching!
Proud of you Clairity!
working in anaesthetics for many years and it still amazes me that you can still always learn so much. Thnks heaps!!!!
Agreed! Thank you for watching!
I have been an anesthesiologist in Brazil for 22 years and I thank you for this amazing tip;🔝👏🏻
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22 years you should’ve known better lol
@@jot5445 And what is it that you do?
@@ZackAG anesthesiologist, you?
@@jot5445 Fair enough. I'm in med school. I stand corrected.
I was a CRNI and PICC certified instructor. I taught my nurses to never use sight to pick the vein. My choice would be a cephaliac or basiliac vein isolated by palpation only. It is imperitive all IV certified nurses know vein anatomy -especially the upper extremities. Both cephalic and basiliac veins tend to be straight, and have large lumens - just as tree twigs, small branches to large branches venous anatomy is very similar. Veins are always bigger in the upper arm than the distal arm and distal arm larger than hand. Observe the posterior hand veins to learn the patients particular size. Then gauge depth by feeling the bounce of the filled vein 1-2 full minutes after tourniquet placement. A bp cuff might be gentler. Observe the skin condition and ask history of diabetes or other conditions such as chronic steroids that may alter tissue integrity and fragility. Remember use your sense of touch, not your vision.
Awesome tips.
Dr Hadzic, the man, the myth, the legend!
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true!!
I’m a former 18D and have learned something from this video. Lifelong learning! Thank you!
Hi Valhalla! Glad to hear this. Greetings!
6M 42s: I was told you should never re-insert a needle into a catheter. The catheter could shard off and go into the bloodstream.
this is why I worked as a phlebotomist, we have drawn blood from peoples upper chest area so many times in obese pts. This just helps when eventually I'm in nursing school to put IV in obese pts.
Nice work, a real smooth solution, offering much less risks compared to central venous access, although you have to see the vein and probably can't enlarge the vein with a tourniquet at this section, unfortunately.
Thank you for your kind comment, glad you found it useful.
I definitely use that vein with obese pts in the ED. It’s heaven’s way of tellin me I’ll get thru my shift just fine 😌. Still, ultrasound guidance in a pinch (code and/or trauma) is also definitely an option (basilic v. just before it branches and and becomes the median cubical v.) As the doc said tho, you need to be well experienced with the machine. No problem with obese patients over here in MD, USA. Good to know that as a tech I’m following the same practice as the docs.
So useful to have another option! Patients will be grateful. Thank you!
Glad you find it helpful! Thanks for watching!
Amazing skill. King of IV skills !
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Very very skillful technique, thank a lot!
Glad it was helpful!
It saved my day too, I kept a very obese patient with a 20G catheter near her deltoid muscle. I’m not proud of it but I’m happy it worked. I have extensive education and experience in point of care ultrasound in anesthesiology: head to toe I use it for every procedure. Though I’d like ultrasound to be the game changer, when the path of peripheral catheter is chosen (vs CVC) it just slows everything down. Congrats on your vid! 👍
30 minutes later, the floor calls because the nurses don’t manage chest IV…. Just kidding!! Great video!
Lol. Indeed possible. Thanks for the note. Greetings!
Lol having worked on the floor before. I can see some nurses doing that.
Thank you. Yesterday saw the video and on same night had chance to use it. Was so happy that succeed
Hi GROKA1984! Glad it helped. Thank you for watching. Do subscribe to this channel and share with your colleagues; a lot more videos are coming up - let's share our clinical experience! Cheers!
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Very informative and useful tipps for not rare difficult situation, thanks alot
Hi Omar! Thank you for your comment. Greetings from NYSORA!
Thank you, great video doctor. Could you please make video about difficult IV access in pediatrics?
Saphenous anterior to medial malleolus or IO for kids!
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Dude, you are part witch. This is off the chain good stuff 👏
I appreciate that!
why is it the better someone is at placing lines, the worse they are at dressing them lol.
Another great video by Dr. Hadzic 👍
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Gracias por vuestras aportaciones, que sin duda nos ayudan a mejorar el abordaje venoso difícil de nuestros pacientes 👍🏻
Great stick anesthesia! Great educational opportunity.
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1. Cut down
2. Lower extremity (saphenous)
Gracias doctor por la sugerencia. Nunca se me hubiera ocurrido. Por allí le estan dejando respuestas espantados acerca que si le pica un pulmón o que si se le infiltra la vía y no se puede ver, comentarios basados en opiniones más que en evidencia.
I have used chest veins and veins in the upper arm to establish access.
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Wow you are the Genius Doc thank you so much.
Dear Imash! You are very welcome. Keep watching- a lot more new videos are coming on this channel. Greetings!
EXCELLENT VIDEO Dr HADZIC.......THANKS
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Thanks for the knowledge. Another addition to my repertoire. RN-EMT here. :)
Thank you! Your comments are much appreciated!
Thank you sir for share this amazing experience with us...love from india 🙏🏻
Greetings to you! Thanks for watching!
Excellent demonstration
Hey DOC7ORT! Glad it was helpful.
Excellent video, like always. Thank you very much.
Very welcome!
Can you give Vassopressors in that superficial vein? Medicine Team says "yes" but Anesthesia team "RIP such vein" ... Good video tbh and next time, try basilic vein in the mid arm with good abduction.... USGIV for deep veins is an art... I would go up to find it, and with a good US even forearm veins are visible and can be cannulated... I was a preceptor of USGIVs for 5 years and I know this business!
Never underestimate cephalic veins in Obese patients - Good one Dr. Hadicz
Yes, but not in a high doses. Greetings
Please more IV videos. Maybe some superficial ivs on the forearm?
Hi Syl, Noted! Thank you for the suggestion!
Amazing thank you for your content, whilst at my Internal medicine internship I struggled with a patient that resembled your case presentation patient, we end up choosing a central venous catheter, (which happen to be ultrasound guided), as it was much more stable, and fortunately it wasnt under any hypotensive nor surgical scenario.
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Thank you very much sir for your kind information. Valuable
Very welcome! Thanks for watching!
Intraosseous is also a good choice
It's life changing information)))))))thank you from my heart!:)
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Wow!! Very very interesting
Glad you enjoyed it!
Another reason why vascular access should be planned and not treated as a step child. To even start surgery on an obese pt. with one IV is poor planning.
Exactly! Prior Proper Planning Prevents Poor Performance.
and this is all yet more good reasons to maintain a healthy weight
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...and light skin.
How about showing difficult techniques with darker skinned folk? It's much more of a challenge that medics should master. Yes?
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Brilliant video but you mention only io in paeds, !we go io tibial or proximal humerus in adults
Thank you so much for providing this!
Glad you enjoyed it! Thank you for commenting.
I learned alot. I will try this technique.
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This is fascinating. Thank you very much.
Glad you enjoyed it!
Never push the needle back into the catheter once separated.
That is really great. Thank you for sharing. We all get better this way. Make sure you subscribe to this channel; a lot more is coming soon! Greetings!
Thank you Doctor
Thank you for watching!
Thank you for sharing your knowledge
Thank you for watching!
Sir.... Please give any tips for cannulating patients with thickened skin ( lichenification )
Your always great 👍
Thank you 😊
Thank you for watching!
Thank you!
You're welcome!
Thanks a lot
Happy to help!
Thank you very much.. very intersting
Glad you liked it!
Thank you very much,very useful..
Glad it was helpful!
In intraosseous access is an option in in adults too, similarly placing a second cannula post induction (and venodilation) in advance can ensure continuity of venous access. I would fully support looking everywhere for a vein, should additional cannulation be required in this case though I personally would have put a tourniquet around the shoulder to improve the chances of cannulation - why make things more difficult?
Thanks Tom. Would be great to refer to a video or an article with description of the techniques mentioned. Always a chance to improve. Greetings.
@@DRBLUESNYC adult IO czcams.com/video/JVNEQgZswiY/video.html but google has lots of others.
@@tomriley5790 Great! Thank you Tom. A great example of how the community can widen your knowledge. Just watched it and learned something new.
Military and civilian medics use IO on adults in pre-arrest situations if peripheral access is difficult.
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Tldr; cephalic vein @ anterior deltoid access can be utilised in an emergency setting of high bmi individuals
Love your videos!
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You can do IO on adults as well now, with the EZ IO drill. Chest veins SHOULD BE AVOIDED unless it's an absolute emergency, and in that case you should just put an IO in. Chest IVs are very risky, especially in females, if you have a bad infiltrate it can lead to the loss of chest tissue, including breast tissue, thus this area should be avoided. I work on a vascular access team and many of the nurses can't even tell when a peripheral IV in an extremity is infiltrated, never mind one placed in the chest area, and this includes ICU nurses who would be hanging pressers. That is also an area that is going to be tough to tell when it infiltrates, even with an experienced person assessing it! Overall not recommended and not a good idea.
I agree chest placements are bad and ridiculous, but an IO would seem extreme if you can’t get basic access. Go to ultrasound with an advanced peripheral or a mid. ie. rep that sells IV’s, mid’s, PICC’s, cvc, acute dialysis and IO’s
Sorry the above^ I read your comment quickly and misread
@@ryants1 IOs are not extreme. We can place them and pull them in the field for our chronic hypoglycemic patients.
@@calebh4442 IOs certainly are extreme on an urgent but not necessarily emergency situation. There are also various contraindications to them that obese patients are more likely to have such as absent landmarks or cellulitis.
Thank you Betty! Greetings! And thanks for watching. Do subscribe to this channel as there's more coming up. And let's share the collective experience so that we all get better in what we do!
this is absolutely rad, thank you
Hey Stronger Medicine! Indeed. Thank you for your comment! Make sure you subscribe to the channel so that you do not miss some super educational upcoming videos!
Another Great Video! Thank you.
Glad you enjoyed it!
I've also has success using visible veins on the anterior chest.
Thank u
Great video
Glad you enjoyed it!
I have the worst veins Ive been told hundreds of times.Mine are sooooo tiny.
We start IVs in infants without difficulty. Do they think yours are smaller than an infants? Doubt it.
Thank you, so helpful!
Glad you liked it!
Can you demonstrate your approach in dark skin individuals?
Thank you for saying that! I was just thinking the same thing. I made a comment live to a TV show where for weeks, it was as if dark skinned people do not get meningitis, as the only symptoms they spoke about or examples featured Caucasian people. Maybe as in your comment, just drill an IO in and let the patient suffer that pain not to mention the agony of the infusion, just because landmarks, examples of working with darker skin were not promoted, shown, or whatever else
Amazing. Thanks Dr.
Hi Ivan! Thank you for your comment. Keep watching!
Very interesting - I think that just goes to show that the "tradition" of using the most common areas for IV access can sometimes be a bit of a trap, especially in potential emergency situations like these.
One small nitpick - I think I saw the needle being pushed back into the catheter after you checked for bloodflow. That seems risky - if we need to prevent unnecessary spillage between removing the leading needle and attaching an IV bag, we just block the vein with a finger, just below where the catheter ends. It can be a bit awkward, yes, but you at least don't run the risk of injuring the catheter.
HI Lukas! Thank you for sharing. Indeed, we all do things differently; in the end - it is what works 4 you. Thank you for watching and do subscribe to the channel - we have a lot more coming up
Problem with these is that i find they tend to rupture pretty easily after a while. They are good for rescue, but not that reliable.. in my own humble experience
Sometimes I use GTN spray on the skin to dilate the veins, I don't know if it makes any difference
Use a RIC line with a wire to size up existing cannulas
*you really felt it neccesary to point out the most difficult IV or V pts youve ever had: AND call them fat?* bc i support that. more of these vids! \^_^/! -JC
Sir, do you think these shoulder cephalic vein tributaries are good for long standing ICU patients? In our ICU sometimes we struggle for IV sites, and also avoid central lines for infection prevention.
NO!
The cephalic vein is okay. However the cephalic vein tributaries are too small and fragile to be used for this indication. Not recommended.
Hear me out! I have a theory! Could it work to spray some nitrolingual spray on the skin, to make the vein dilate, and make it easier to hit? I havent been able to test this properly! Has anyone else ever thought about this?
No.
@@wholeNwon Nice argument and reasoning! Thanks 😁
My granddaughter is VERY overweight, it took the nurse forEVER to find a vein
can u use leg veins?
4:47 - nice superficial vein there :) Just above the brachial a. Provided US is available, and it generally is, I find distal arm easier to access than shoulder.
Yes! “There’s no vein.” Um, sir, it’s right there.
How long do Iv’s typically last for. Mine only last for 2-3 day max.
Great sir
One of the biggest concerns with an IV catheter placed in the chest is the delayed recognition of infiltration. Infiltration in the upper chest cannot be detected as easily as it would be with a more peripheral line.
Also, the use of an IV catheter that is intended for peripheral veins could violate hospital policy as the catheters are only manufactured for veins in defined limbs. Please be sure to remove the line in PACU upon the return of more peripheral venous prospects to protect your patient and your license.
This is supposed to be for an emergency in the middle of a surgical procedure. Not for primary site beforehand. It is close to a last resort in a difficult, obese patient.
@@rdizzy1 The points I made were to benefit viewers of the video as well.
Hey Sammy N! Great. Thank you for sharing. And make sure you subscribe to this CZcams channel - we have a lot more really interesting videos coming up soon.
Thank you for watching. If you found this video useful, make sure you watch the latest release with complimentary information czcams.com/video/CGaMWDI6Vxk/video.html And do not forget to SUBSCRIBE and never miss new releases. Greetings from NYSORA!
Thats a great tip Prof, can you please tell us about the action of muscle relaxant that was injected inadvertently in a cannula that happened to be malfunctioning
Does that extavasated muscle relaxant or other anesthesia medication contribute to delayed absorption and its consequences delaying the recovery
Relax
Indeed in this scenario the muscle relaxant can linger subcutaneously or repetitive initially and be slowly absorbed systemically and possibly create problems.
Bring out the IO drill and go brrrrrrrrrrrrrrrrrrrrr.
Thank you for this I was in the middle of surgery and couldn't manage. Watched this video while the patient was dying and he's fine now 😃
How come they dont teach this in nursing school?
Look at anesthesiologist stealing our opportunity using ultrasound on patients
Where do you position a tourniquet to access the cephalic veins? Or is it necessary?
Thank you🙏,so no torniquet needed in this site?
Under these conditions would an IO not be your preferred access
with an obese enough patient it may not be possible to palpate the landmarks properly
Could we also used and IO line?
Did you guys just go for the IV visually? Usually it's so hard to go by feel for obese pts.
Дякую Вам
👋🇺🇦🙏
Any worry about a brachial plexus injury with this site? I guess the key would just keeping super shallow
You are using a Proseal Mask without a gastric tube in this very obese patient? Quite dangerous, this patients risk for aspiration seems quite high, so the „non-use“ is a personal mystery for me.
Can you explain it to me why did the general anaesthesia without it?
Hi there. Thank you for the valid comment. Indeed, higher generation supraglottic airway with aspiration port would have been a better choice. Sometimes the choices are made based on what you currently have, patient's airway and/or specific surgery, and individual practitioners preferences/experience. In this case - the surgery was on the distal lower extremity. Some colleagues would routinely opted for endotracheal intubation and a gastric tube. For short distal extremity surgery, I would personally opt for 2nd or higher generation LMA and slight chest-up positioning, rather than the endotracheal intubation and muscle relaxants. Again - thank you for the comment and thanks for watching.
@@DRBLUESNYC In this case you did use a second generation larynx mask indeed, but the port for the gastric tube is empty, if my eyes are right. Look at 6:42-7:00min from the video behind your head.
But only a question, I like your videos very much. Also I improved my techniques for Regional Anaesthesia a lot from your vids and app. So thanks a lot!
@@ghosti8691 Sharp eye! Again, thanks for your comments and the accolade. Admittedly, with the focus on the IV, we have de-focussed on other important elements of this case that I do not have much additional details on. So, thanks for bringing it up.
@@DRBLUESNYC great! Thanks!
Thank you for watching. If you found this video useful, make sure you watch the latest release with complimentary information czcams.com/video/CGaMWDI6Vxk/video.html And do not forget to SUBSCRIBE and never miss new releases. Greetings from NYSORA!
emergent cutdown
Exactly right
or IO. Or don’t start with only one questionable cannula in the first place.
in black skin ppt??
This question has been asked so many times. Still, no response
Ultrasound : )
nice
Holy catheter shear Batman!! 🤯