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.

This video is an operator point of view recording of an ultrasound guided central line insertion in a 2 stage simulator. This is the view from a head mounted camera so there is a bit of movement, careful if you easily get motion illness.

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.

Are you using an ultrasound phantom task trainer for central venous catheter insertion training? If you are have you noticed the vessels are becoming purple rather than staying red and blue? There could be a fistula between the vessels in the phantom from punctures.

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.

The Accucath is a peripheral IV with an integrated wire for a seldinger technique placement. This video reviews using the device with ultrasound guidance. I prefer to capture images of the target vessel and the wire in place after cannulation to show your targeted vessel and successful cannulation of vessel.

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.

This video is a short primer on basic ultrasound physics. This is designed to help people who are starting to use point of care ultrasound for the first time for procedure guidance. This is an introduction primer and not meant to be exhaustive nor comprehensive.

This is an introductory review of the basic knobology of the SonoSite M-Turbo system and how to interact with it. Does not cover all functions of the system. Some buttons are different from the Micromaxx, Titan, and Edge. The A and B Button can be customized based on your preferences in the Setup menu.

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.

This is a video showing the use of the Kyoto Kagaku Ultrasound Guided PICC Phantom. Access to the vessel was done using a micro puncture needle and in-plane realtime US guidance. The wire threaded is both the micro-puncture wire and the regular wire, both straight tipped.

Clearing the Memory on a SonoSite Turbo

It is that time of year again with new residents and fellows for ultrasound programs.  Many Emergency Medicine programs are now using digital arching solutions for their ultrasound studies.  Also becoming popular are the use of middleware and/or PACS systems for quality assurance and education/feedback.

One problem that occurs if you are using a SonoSite system is that the studies are saved to the hard drive or internal memory before transmission to the middleware system, such as Q-Path.  Eventually the internal memory of the ultrasound unit will fill up.  When the memory is full the boot time can be longer and performance may suffer.  Most importantly you will NOT be able to save further studies to the hard drive in order to transmit to the arching solution you use.

Someone has to clear the memory periodically.  Unfortunately if you have several sites this could become a problem with schedules and new people in the program.  This short video is a walk through of how to clear the memory on the M-Turbo system from SonoSite, it also works for the Edge system.  Feel free to distribute the link to you people in your program or if you get that late night call asking how to clear the memory.

Video instructions on how to clear the hard drive of the M-Turbo ultrasound system. When the hard drive is full you will not be able to save studies to the hard drive. The system saves to the hard drive before transmitting to your image archiving system.

To make things easier to distribute you can also use this shortened link that will take you directly to the YouTube video:  http://bit.ly/clearturbo and is easier to remember.  Or you can use this QR Code:

Central Line Kit Walkthrough and Line Placement

Originally Published: 2013-Jul-02

This video is a walk through of placing an ultrasound guided internal jugular central line in  a sterile fashion.  The technique and individual steps will depend on the brand of kit and how it has been customized for your institution.

This video was originally created as a review for the residents at my institution.  It focuses on the process of placing the line and less so on the ultrasound guidance.

This is a multi-angle video filmed in a simulation environment to walk through the use of this particular central line kit. This video focuses on the process of inserting and securing the central line. This was designed as a review of the procedure steps for learners at a specific location with a specific kit.