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.

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: Phantom model was provided by Kyoto Kagaku for evaluation.

From Twitter to Tenure: SAEM 2014 Annual Meeting

At the 2014 Society for Academic Emergency Medicine Annual meeting Michelle Lin (M_Lin), Nicholas Genes (@NickGenes), Robert Cooney (@EMEducation), and myself (@takeokun) give a didactic session entitled “Twitter to Tenure: Use of Social Media to Advance Your Academic Career”.

We discussed the relationship of social media and #FOAMed to scholarship, the traditional markers of academic scholarly activity in the setting of US Graduate Medical Education, and our experience in social media over the years.  Here is a recording of our lecture presentation and the questions from the audience.  The audio is limited due to some technical difficulties while traveling.

I would also pay attention to the discussion from Ed Panacek at about 57:24.  Ed has some very important things to say about social media and academic careers/advancement, Michelle may have also let a little surprise slip.

This video was in collaboration with:

Michelle Lin MD   @M_Lin   http://academiclifeinem.com

Nicholas Genes MD PhD   @NickGenes   http://blogborygmi.blogspot.com

Robert Cooney MD RDMS   @EMEducation   http://flippedem.com

Hope you all enjoy.

Resident Education in Ultrasound Using Simulation and Social Media AIUM14

There was a session at the American Institute of Ultrasound in Medicine 2014 Annual Meeting focusing on education in Point of Care Ultrasound.  There were several speakers and I was asked to speak on resident education, particularly to focus on simulation and social media and how it fits with EM Resident ultrasound education.  This is a fairly large and broad area to cover in 15 minutes or less.

I chose to focus on how to simulation and social media can assist in education and deliberate practice to get learners to an “expert performance” level.  The information may not be new to people who are familiar with simulation or social media. My goal was to show how these things can be helpful from a conceptual and design view for education.  Also to provide information that you can use if you have to justify to others why social media or simulation is important to your educational program and why it should be supported.

This is a recording of the presentation, sorry the audio is not as clear but did not have the external microphone for the recording.