How to Place a RIC Line - Very Large Bore Peripheral IV (Intravenous) Access Catheter
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- Опубликовано: 7 авг 2024
- This video details how to place a RIC (Rapid Infusion Catheter) intravenous trauma catheter. The catheter is designed to be placed rapidly and easily during trauma and large volume hemorrhage situations. These lines are often used in anesthesiology and emergency medicine practice.
This vascular access (IV access) technique may be of interest to anesthesiologists, emergency physicians, trauma surgeons, nurse anesthetists, and emergency providers of all still sets. These catheters offer rapid infusion rates faster than trauma central lines like the cordis. Key: Massive Transfusion, PIV, phlebotomy.
Teleflex Arrow Product Link: www.teleflexvascular.com/prod...
*I have no financial connection to this product or Teleflex. 
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Dr Marc, I'm your 200th Subscriber. ❤️ You're video are absolutely awesome and mind-blowing informative. 😁👌 Please keep up the absolutely amazing work 🙏🏻💯
Namaste from 🇮🇳
Thanks so much!
Perfect video for teaching us the young residents 👍👍
Great! That's exactly the group I made it for, actually.
Marc is there a way to download this video? I'd like to use it to teach! Great video!
That's a nice practice arm!
Do they have a tool to break out the core of the anti-reflux valves on some IV catheters? Maybe just a way to secure the cannula and cut off lock to allow feeding guide wire in before removing catheter. I've heard of docs losing guide wires in patients, when doing central lines. Should the end be bent/secured before insertion?
In reality you would never let go of the wire
It's definitely important to have a good grip on the wire while advancing the catheter and I'm not necessarily claiming that a wire being "sucked" into a vein is a myth, but the fact that about 90% of lost guidewires are discovered post-procedure (Mariyaselvam et. al. 2021) suggests that the issue is one of inexperience and distraction rather than some weird physiologic phenomenon.
Either way, I do let go of peripherally placed venous wires all the time and have not had any issues after a decade of doing it that way. (hashtag not medical advice)
It's possible to get the wire through the anti-reflux valve, it just takes a few tries to get the wire exactly in the center without catching, so I wouldn't mess with pulling out the valve. I wouldn't bend the wire, as it would make it harder to put the RIC catheter on after removing the 20 Ga. As far as lost wires go, I think simulation is the answer to that; a major component of lost wires is a combination of stressful environments (code, trauma, etc.) and inexperience.
Haven’t done one yet
I guess you need to take more call with me :)
I know this comes with experience and every patient is different, that said what are common good locations for RIC line? You mentioned AC. Anywhere else?
I don’t regularly place it anywhere other than the AC. I’ve placed it in good forearm veins a couple times. I recall an occasion where one of my colleagues placed one in a hand vein but the vein was pretty much destroyed postoperatively so I’d leave the hand as a last resort.
What's the price of a 7 fr ARROW kit? Can I buy RICs in bulk?
I don't do the purchasing for my institution so I don't know what the bulk/wholesale rate would be. A quick google search shows me at least one retail site that sells a pack of 25 for $250.
@@DrMRod where did you get the demo supplies for this video?
Hi, I'm also an anesthesiologist. I am from Brazil. I recently started 3D printing and ended up finding your channel and website. If possible, I would like you to send me your contact details to find out a little more about this world.
What is the point of such a big iv ?
It says so in the description. It allows infusions to get into the body rapidly, which is used for trauma patients etc.
Big pokey thing=faster fluid flow
I'm losing my mind every time I see a guidewire being placed completely into a dilator/catheter. Maybe it's not a big deal if it's peripheral... but still
In my opinion, can confirm that with peripheral access, it is less of a big deal, #notmedicaladvice. This has been my practice with seldinger technique for peripheral venous access for some time and I haven’t had any lost wires in about 10 years of doing it this way. Even with CVCs, research suggests that the issue of lost wires is mainly one of “forgetting” about the wire rather than it being pushed/pulled/sucked in (Mariyaselvam et. al. 2021).
Hopefully we can avoid this!
Seem pretty useless, with most common guide line even a 18G IV catheter is ok. That said great video! By from italy !!
"Useless" is pretty subjective, it depends on the use case. Liver transplants, massive trauma, placenta accretas; one can easily lose 10 Liters or more of blood and lose it very quickly during these cases. Are you going to be able to keep up with 1 Liter per minute blood loss from a hemorrhaging uterus for 15 minutes with two 18 gauges while the surgeons work to control the bleeding? Probably not.
@@DrMRod yeah is subjective! It depend even if the MET has good experience with it and the Emergency room organisation.
But if the patient has gone to that point without a power injectable central IV i would ask my self a lot of question tbh and yes u got a point in the trauma but i don’t think so for the other two 😅 That said it’s a cool product for when thing go f wrong!😎
@@Flavio-cv5cw It's pretty common to get trauma patients that come direct to the OR with minimal intervention in the ER; it's a lot easier for me to place a RIC line (vs CVC) so that I can keep up with the surgeon cracking the chest open. Either way, in a trauma setting, a CVC is always second line after good peripheral access; there's a reason every trauma protocol includes "two large bore IVs" in steps 1 or 2.
I am a trauma anesthesiologist and I agree with Dr. Rodriguez. 2 18G PIV wont cut it with multiple GSWs to the chest. My trauma surgeons are usually pretty good about inserting a CORDIS in the ED, but if they don't, a RIC is much faster for me to place than a central line, and with a Belmont rapid infuser flows just as fast.
Once you’ve been around awhile you know that an 18g cannula (even if you have 2) doesn’t cut it when you have torrential bleeding as for example placenta accreta, ruptured uterus, trauma etc. Sometimes patients can exsanguinate in front of you and I agree a Belmont fluid infuser on a RIC line is a lifesaver.