The Ski-LIft: a technique to help with ultrasound guided access

This is a repost of an older post from the old version of the blog.  The video is the original and a little older quality.  I plan to eventually redo the video with some additions; but for the time being here is the video for reference and education.

 

My colleagues and I published an article in Academic Emergency Medicine, the journal for the Society for Academic Emergency Medicine, about something we termed the Ski Lift.  This is a method to help assist in viewing the needle during in-plane guidance for realtime ultrasound guidance for vascular access.

A brief description is presented here with a video, the full article can be found at:

Academic Emergency Medicine Vol 17 Issue 7 Page e83-e84, July 2010.

  1. Obtain a sagittal view of the target vessel
  2. Stabilize the transducer and brace your hand.  Then rock the probe to elevate the proximal section.
  3. Place the needle in the center of the probe (usually at the case seam) and under the probe footprint.
  4. Stop rocking the probe so the entire surface is again contacting the skin, the needle tip should be immediately visible.
  5. Advance the needle to the target vessel

Introduction to Ultrasound Physics for Point of Care Users

Video of basic ultrasound physics for the point of care users who is starting to learn ultrasound.  Targeted at new and early users including residents.  This is a more expanded version of the primer video that was a bare bones discussions.  This cover the majority of topics that would be needed to start the resident education for meeting ACEP guidelines at graduation and the EM-RRC Milestones.

SonoSite Turbo Hard Reboot Instructions

This is a short video demonstration with instructions of how to perform a hard reboot on your SonoSite Turbo system should it freeze and be non-perational.

Most times when the system, touchpad, or keyboard freezes you can hold down the power button until it powers down for a soft reboot.  If this fails you have to move onto the hard reboot.

This should also work for your other clamshells systems (MicroMaxx, Titan, and Edge).  However, the S series is set up a little differently.  The Exporte has a whole different setup for reboots.

US Guided Central Venous Catheter Kit Walk Through

This is a video from operator point of view of the placement of an ultrasound guided IJ central venous catheter.  The video uses a head mounted camera so there is a bit of movement so warning if you get motion illness early.

Yes I know, the bedside table had to be elevated for the camera angle and images so the edge of the kit wrapping relative to the drape is not ideal for sterile technique.

The video uses a Cook Spectrum antibiotic impregnated catheter with a Biopatch, chlorhexidine impregnated bandage.  Central line kits and contents will vary based upon manufacturer and customization.

Video provided for educational and informational purposes only.

I do not currently receive any funding or support from Cook or Biopatch.

Central Venous Catheter Task Trainer Phantom with Purple Vessels

If you are using task trainer procedural phantoms for ultrasound guided vascular access you may notice a problem over time.  The phantom vessels may start to be filled with purple fluid.  If you have blue and red liquid to differentiate the artery versus vein in the phantom there are 2 reasons you could have purple fluid.

  1. Aspiration of fluid from one vessel and re-injection into the other, mixing the red and blue to form purple.
  2. There is a fistulous connection between the artery and the vein.

If the purple fluid is due to aspiration and injection of fluid from one vessel into the other that is easy to fix.  Drain and refill the vessels with red and blue.  Then instruct your users not to re-inject the fluid in to the phantom vessel.  Instead dispense of the aspirate into a container on the side with a separate one for each color.  This will prevent mixing and injection of air in to the vessels leading to artifacts.  This will also prevent the accidental injection of fluid in to the phantom tissue itself which can damage the inserts and reduce the life of the phantom.  You can then inject the fluid through the fill port later.

The other reason is if you have a fistula between the vessels.  The following video shows what an aterio-venous fistula can appear like on the phantom with both an electronic and hand pump model.

One way to fix both problems is to fill the vessels with a single color fluid so if there is mixing or a fistula it won’t matter.

Instructional video for the Accucath by Vascular Pathways (Bard)

Originally Published: 2015-Apr-29

Since this was originally published the Accucath has become a Bard product.

As a disclaimer I do not currently receive any funding or support from Vascular Pathways (or Bard). The devices are purchased by the healthcare institution where I practice.

The Accucath device is a peripheral intravenous catheter that has an integrates coil tip wire to allow a seldinger type insertion technique.  Think of your arterial catheters.

Theoretically this would allow you easier placement in smaller and more difficult vessels.  It is also supposed to help you navigate through valves and avoid small side branches (all of which I have had experience with and it can be frustrating).  This is a newer device and I have had good success with smaller vessels, however, we will see what happens as more difficult access cases occur.

Below is an instructional video on using the Accucath 2.25″ device for venous access.

I tend to capture an image of the wire in the vessel and the catheter in the vessel if I am able to based on the clinical situation.  I also tend to document that the wire was removed intact, at least currently since this is a newer device in my institution.

Primer Videos for Ultrasound

These 2 videos are meant to be primer videos for point of care ultrasound. These were designed to be used as part of a procedural education course.  The physics and knobology presentations are meant as an introduction and not as exhaustive or comprehensive reviews.  Think of them as for people who are starting to learn procedural ultrasound, off service residents who need an introduction, or even medical students rotating in EM.

Enjoy and feel free to use as you see fit, no point recreating the wheel.