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.

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

 

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.

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

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