Cite this post as:
Scott Weingart, MD FCCM. EMCrit Wee – Central Line MicroSkills (Deliberate Practice). EMCrit Blog. Published on September 12, 2015. Accessed on January 20th 2025. Available at [https://emcrit.org/emcrit/central-line-micro-skills-deliberate-practice/ ].
Financial Disclosures:
The course director, Dr. Scott D. Weingart MD FCCM, reports no relevant financial relationships with ineligible companies. This episode’s speaker(s) report no relevant financial relationships with ineligible companies unless listed above.
CME Review
Original Release: September 12, 2015
Date of Most Recent Review: Jul 1, 2024
Termination Date: Jul 1, 2027
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Great video!
I would add a micro skill whih pertains to advancing dilator over a wire. This is teh phase I find more practitoners having difficulty and bending the wire. The emphasis should be glding the dilator while pulling the wire to prevent kinking of the wire itself.
I agree with adding a dilator mico skill, specially when you are inserting a large bore dialysis catheter
I thank you a million times for micro skill # 4
Nice job explaining the little details. Those skills you only learn when actually doing the procedure.
Thanks Scott!
When detaching the syringe, aren’t you supposed to occlude the needle hub to prevent air embolism ?
How do you do this while maintaining the ‘bridge’ ?
You do not. Your patient should already be in trendelenburg and the positive pressure in the vein should cause blood to dribble out of your needle. This should preclude an air embolism. If you the procedure with the patient flat or sitting up a thumb occluding the needle is unlikely to prevent an air embolism when the patient inhales. Hope that helps
Great tips, thanks for all that you do.
Great video Scott – filling a large education niche for many a junior registrar starting out in critical care. I’ll be sending them all to your video before setting loose on real people…. Nuances you might consider adding include setting up “micro-habits”; like always using one size syringe for local and a different one for saline (if you are a line flusher….), always fixing syringe markings/gradations in same plane as bevel of needle (so you know which way bevel is pointing if needle slips/rotates), never aspirate more blood than you need to demonstrate intravascular position, so that you can pull… Read more »
I’ve been practicing intensive care medicine for the past 12 years and I had never heard someone teach about straightening the J point of the guidewire before your show. Thank you Scott! I’m a big fan of yours and avid listener of Emcrit.
Great video Mr NewYork! 2 quick comment:
– I stopped using the needle long time ago, can’t remember where I heard this tip, but using the needle over catheter that comes with all central lines has made it a lot easier. It is just like cannulating any vein. I push the catheter over the needle, then I don’t have to stabilize anything, and just continue with wire.
– Keep the needle bevel down. It has less “almost-in” mistakes and less back walling the vein.
Gracias !
For Microskill #1, one way I simulate this is by putting a red cap (the plastic bit used to cap syringes or stopcock hubs) on the end of a 5 or 10 cc syringe and then show folks how to aspirate while manipulating the needle. this is an “A-ha” moment for a lot of folks. Great episode.
Nice video Scott, thanks!
My RT instincts were distracting me though… the vent behind you had the circuit laying on the floor (admittedly inside a plastic bag) and your RTs inexplicably added an extra filter right in front of another high efficiency filter, which is just kind of weird. Sorry… just getting that off my chest. Haha.
When I discussed microskills with Levitan at SMACC, he said he preferred a technique where he could stabilize his guidewire hand against his needle hand for ease of threading the guidewire. Thoughts?
http://www.emergency-medicine1.tk/
Would Chen be a better representation or Meepo?
Thank you for this Scott! Just thought I’d share some of my experiences. I have found that I have more control of the syringe when I actually grip the whole syringe with my hand and use my ring finger to aspirate as I penetrate the skin. This is also far more comfortable when doing certain central lines that take longer than you would otherwise expect. I would also suggest that once you have the needle secured with your non-dominant hand that you aspirate a little with the syringe again prior to removing it. This confirms that your effort at controlling… Read more »
very cool. thank you, scott
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Very informative video, being a part of medical side it’d give immense knowledge to everyone.
Lars Medicare, one of the leading manufacturers of medical disposable products.
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Mais India is one of the leading names in the healthcare sector. It is a Medical Disposable Equipment Manufacturer Company, Our products are – Iv cannula, safety iv cannula,3way-stopcock, 3way-stopcock with extension tube, foley catheter, endotracheal tube, pressure monitoring line, etc. The motto of Mais India is to ensure that single-use medical products reach the globe at affordable prices but at an unbeatable quality conforming to international standards.
Anyone have any idea why this happened in this patient ? Trying to figure out why so it doesn’t happen again. Valve ? Guide wire malfunction ? Thanks !
Simon Lee
Likely there is some central stenosis or a central DVT that precluded the catheter from straightening out. Less likely is if it passed into an unusually positioned anyhow. Thanks, hope that helps!
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