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.

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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.

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SAEM 2015 Twitter Transcript

The Annual Meeting 2015 for the Society of Academic Emergency Medicine (#SAEM15) was held in San Diego from May 12, 2015 to May 15, 2015.  The first day of the conference dates was the Consensus Conference and the pre-day workshops on various topics.  Main days of the conference were the 13th to the 15th.  Also during this conference was SonoGames run by the Academy of Emergency Ultraosund (#AEUS @SAEMAEUS) and Sim Wars.

There was a much higher volume of tweets than in previous years from a quick run through; as is the case with most conferences.   There were many EM physicians tweeting from the conference and retweeting to disseminate information and tips making use of #FOAMed.  There were also several didactics and discussions about #FOAMed and social media during the conference.  You may have also heard that @SAEMonline does have a social media committee chaired by @EMDocBrett with many EM tweeps as members.

Below is a graph of the tweet volume as captured by @symplur for the conference.

Below is the link to the Twitter transcript for #SAEM15 that I was able to capture via searching the hashtag with retweets removed.  There are 2,784 tweets that were captured leading up to, during, and the day after the conference.

Twitter Transcript from #SAEM15

 

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Instructional video for the Accucath by Vascular Pathways

As a disclaimer I do not currently receive any funding or support from Vascular Pathways. 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.

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Summit on Clinical Ultrasound Fellowships 2015 Twitter Transcript

This April was the inaugural Summit on Clinical Ultrasound Fellowships at the Mass General Hospital in Boston.  This was the national meeting for the Society of Clinical Ultrasound Fellowships (SCUF) which grew out of the organization of EUSFellowships.com.  This encompasses the member programs that are running Emergency Medicine or Clinical Ultrasound Fellowships.

There were presentations, group discussions, and panel sessions.  Overall a very helpful and worthwhile meeting whether you are currently running an ultrasound fellowship, in one, or thinking about starting one.  Many attendees are on Twitter and were tweeting from the conference along with the MGH program using periscope to live broadcast the sessions to those who could not attend.  Below is the tweet volume graph from Symplur.com for the 1.5 days summit.

Below is a link to the transcript without retweets repeated from the conference.

Twitter Transcript from #SCUF15

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AIUM 2015 Twitter Transcript

The American Institute of Ultrasound in Medicine Annual Convention was held on March 21-25, 2015 as a joint conference with the World Federation of Ultrasound in Medicine and Biology Congress.  The desginated hashtag was #AIUM15.  Below is a graph showing the tweet volume and trend from Symplur for the conference.

Below is a link to the twitter transcript with retweets removed.  Searching briefly before, during, and the day after the conference yielded 1,182 tweets from a variety of users.

Twitter Transcript from #AIUM15

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ACEP 2014 Twitter Transcript

The American College of Emergency Physicians had the Annual Scientific Assembly in October 27-30, 2014 in Chicago.  There were many didactics, research, vendors, and meetings.  Lots of great work done and publicized on Twitter with #ACEP14.  There were a total of 7,605 tweets captured in the search which ran for a few days before and after the conference dates.

The Symplur Hashtag project tracking shows a graph that shows the volume over time.

The linked document is a PDF of all the tweets captured on search with #ACEP14 in reverse chronological order.  Retweets are not included.

Twitter Transcript from #ACEP14

 

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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.

Primer on Ultrasound Physics

Primer on M-Turbo Knobology

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Kyoto Kagaku US Guided PICC Phantom: Hands On

I got the chance to use and evaluate the Kyoto Kagaku Ultrasound guided Peripherally Inserted Central Catheter procedure phantom.  The phantom consists of a torso and an arm that articulates at the shoulder to be able to place the arm in different positions.

The upper arm has a replaceable area that can be ultrasounded and cannulated.  The targets are the cephalic and basilic veins.  The vessels outside of the insert are clear so you can see the wire and/or catheter threading. There is the ability to place the wire in to the SVC and the IJ.  There is a vessel that is used to fill the model and could be considered an azygos vein, but its take off is a little odd.

The video goes over the phantom’s parts and images along with demonstration of access and wire threading.

Disclosure:  PICC Phantom was provided by Kyoto Kagaku for review.

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Twitter Transcript from SAEM14

Here is the Twitter transcript from the Society for Academic Emergency Medicine 2014 Annual meeting, #SAEM14.  During the conference we became a world wide trending topic thanks to the discussions and retweets.

 

We also had a record number of attendees at the conference along with an increased number of people on Twitter and number of tweets.  Nowhere near the numbers that we get for ACEP but growing.  The Symplur graph shows the volume over the conference.

Download the Twitter Transcript pulled from Hootsuite.

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