Ultrasound-Guided IV Access
Length
We are using catheters that are too short!
You want 2-3 cm in the vessel (at least)
Better to have longer catheters standard 5-6.4 cm
I use 10 cm midlines for this placed by seldinger [see the EMCrit Midlines Episode]
Transverse vs. Longitudinal
Angle of Insertion
Shallower is probably better if you can make it happen–this usually requires a longer catheter
Find the Tip in Transverse
Fanning and Sliding
How to Train
Chicken or turkey breasts with fluid filled balloons (use knitting needle to push the balloon through the breast
Spinning the Needle 180°
If you don't have much room in the vessel to advance without backwalling, then inverting the bevel may be the trick to avoid scraping the vessel or backwall puncturing
Securement with Diaphoresis
Can try skin glue, but I think sewing them in is the only answer
Site
Hand is worse for longevity
Forearm may be the optimal site both for avoidance of movement and hemodilution from the numerous branches in the forearm
Midline Debate
- Metas-Analysis: Comparing Complication Rates of Midline Catheter vs Peripherally Inserted Central Catheter [10.1093/ofid/ofad024]
- RCT:
Central Lines
Tails turned down on IJs
Primary Securement
Adhesive Dressings
Subcutaneous Affixation Devices
Skin Glue
Where to Find the Vacular Guy
- Youtube
- TikTok
Additional New Information
More on EMCrit
Additional Resources
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Professor
Nassau University Medical Center
No conflicts of interest (coi).
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An other cheap training “fantom”, is a block of tofu. Need to change the gain all the way down.
Thank you.