Cite this post as:
Scott Weingart, MD FCCM. EMCrit Wee – Central Line MicroSkills – Dilation & Dilators. EMCrit Blog. Published on August 29, 2017. Accessed on March 29th 2024. Available at [https://emcrit.org/emcrit/microskills-dilation/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: August 29, 2017
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Vamsi Aribindi, Gen Surg Resident-
For the ripping manuver, aren’t you damaging the same fascia that you are hoping will seal around the tube and prevent infection for central lines and air leaks for pleural catheters? Steady pressure until you are through should result in less fascial disruption.
The racking though is a great tip and one I use, after learning the lesson about wire kinking the hard way.
nope
in an ideal dilation, the dilator would be able to spin without resistance. which is what you are achieving. there is no problem with seals. you can’t dilate a path larger than the dilator itself. gentle pressure is just grand until you get to large dilators. then you have a choice–less than gentle pressure or twisting.
You play DOTA Scott?
Commended
I was exceedingly pleased to load up emcrit and see the Meeps.
gg wp commended
Really, I’ve got a PVC when I saw the old good meepo.
thank you, scott.
placed a 8.5 fr fem vein line today, and taught a “fellow”, using much of what you taught me.
also referred her to the nathanson video (paul marik. sept 1) regarding the politics of the edwards catheter.
thanks.
Great post! I was hoping I could ask a few questions about introducer sheath insertions as well as general questions about dilation. I know this was posted a long time ago so hopefully it is read. 1) Do you use the same technique for the insertion for a cordis, that is do you twist while inserting, or do you do the twisting and pull back method to break up tissue? 2) Can you explain why twisting the dilator during insertion is useful. I do it too but was wondering if there is an explanation why twisting works better than just… Read more »
1) Do you use the same technique for the insertion for a cordis, that is do you twist while inserting, or do you do the twisting and pull back method to break up tissue? twisting while inserting doesn’t really accomplish anything in any circumstance with a 9 F cordis, you don’t need twist and rip, not that you can do it with a cordis anyway. 2) Can you explain why twisting the dilator during insertion is useful. I do it too but was wondering if there is an explanation why twisting works better than just advancing. What is the physics… Read more »