Ever since I first tried it, I've used the Pajunk E-Cath (CON) almost exclusively, the exception being it's unavailability. I've even resorted to simulating the E-Cath by substituting just a regular IV cannula, a throwback to the early days when the Abbocath was the norm.
Passed my first over the needle catheter a week ago, so smoothly, I am so impressed with these Pajunk devices, much better than using Tuohy e epidural cateter like we were used to do.
Although I've not used CON, we have only used B brown C catheter (CTN), the above mentioned problem of catheter dislodgement during shoulder surgery for interscalene catheter can be real. Plus stiffness can be limitation for CON. Leak is genuine problem with CTN which might be less with CON. Thank you for your inputs on both systems. The comments also are very helpful.
Greetings. Thank you for the feedback. Which catheters specfically do you use, actually? And do you place it in plane or out of plane and how deep beyond the needle tip? Greetings!
We place 150-200 catheters each month across multiple service lines. We prefer the over the needle from Pjaunk. We have found less catheter leakage. The ease of placement and the visualization make it a much better option for our residents. However, we recently discovered some issues with our interscalene catheters migrating from the brachial plexus with movement of the shoulder during surgery. We attributed this to the rigid sheath of the catheter. We look forward to trying the new softer more flexible catheter they have designed.
Thank you for the feedback. THat is a LOT of catheters. |WHich institution is this? And how long does it take a staff member to place and secure a catheter-over-the-needle perineural catheter?
Admir, I've done over 4,000 catheters since 2005 (starting before the adoption of ultrasound). I've used both CTN and CON, and i've tried many manufacturers over the years. All your pointers are correct. There's also some CTN catheters, those by Arrow with a metal coil at the end, that have been difficult to remove, because of tissue in the coil. Also some CTN that get knotted if threaded too far in. And some CTN that are so flimsy that they won't thread. And the early CON catheter that Bill Urmey developed was over a very small gauge needle that kinked if inserted without using their special clip, so you had to throw away the whole thing. I still use both types but I'm liking the CON more now, EXCEPT for adductor canal placement, where it has a higher likelihood of dislodging. So best if you can stock both types and use appropriately, understanding all pointers you mentioned.
Hi Elie. 100% agree. In fact I have witnessed 2 Arrow catheters with the coiled stimulating wired tip being adhered to the tissue requiring an intervention for removal. Those do not have place in today's practice. Also stimulation with catheters does not make sense - it mandates additional uinnecessary steps. WHat are the blocks you use CON for mostly? Greetings!!!
@@nysoravideo nowadays workload has decreased as I ease into part time workload. I still do catheters, down to 2-3 per week only. Ideally, CON for popliteal, supraclavicular and interscalene. CTN for adductor canal.
Hi Dr. Admir, I am currently inserting around 60-80 catheters per month. Recently, I changed my practice to using Catheter Over Needle (CON), and I’ve tried both B. Braun and Pajunk products. I found that the Pajunk catheters offered better visualization under ultrasound, so I prefer to use them. However, I encountered some limitations with certain blocks that require deeper catheter advancement, such as SIFI catheters. For these cases, I still use the Catheter Through Needle (CTN) technique, while I use CON for the remaining blocks, as it helps to reduce the load on my Acute Pain Service (APS) team by minimizing leakage complications.
Very insigthful! THank you for sharing. Can you describe those limitations you encountered, we also think that for deeper blocks - different catheters are better. Greetings!!!
@@nysoravideo To overcome the challenge of catheter advancement in deep blocks like the SIFI, I’ve been using a technique that involves the B. Braun Contiplex C system. When I reach the target space, I withdraw the needle slightly and advance the catheter an additional 5-10 cm into the fascia iliaca plane. This method helps ensure that the catheter remains in the optimal position for continuous analgesia, addressing the limitations commonly seen with standard approaches. However, with the E-Cath system, I’ve noticed that achieving the same level of advancement is nearly impossible due to the restrictive sheath, which limits the catheter’s ability to move forward beyond a certain point. This design feature of the E-Cath can be a significant drawback in cases where deeper placement is crucial for effective local anesthetic spread in the supra-inguinal fascia iliaca block. I’d be interested to hear if others have found similar challenges or have alternative techniques to maximize the catheter placement with these systems!
It is included. This educational video was sponsored by Pajunk. However - it discusses catheter designs but it does not promote a specific catheter brand.
Good morning. I have a question, is it possible to give you spinal anesthesia? to put the back to sleep during scoliosis surgery? while remaining awake because I am declared inoperable because of my very low respiratory capacity, thank you for the answer.
Good morning. No. SPinal anesthesia would be a risky choice for your operation as the level of spinal anesthesia needed for your operation would most definitively interfere with the breathing. Regardless, spinal anesthesia is almost always possible.
@@nysoravideo This would be the only solution because my scoliosis is progressing and it has worsened my respiratory capacity by only 10%, so it is too risky or even impossible to intubate myself during the operation. There is a high risk that I will not wake up after the operation. the only solution is to do spinal anesthesia to put the back to sleep while remaining awake during the operation... Without surgery I would be dead in the next few months. I'm too young to die at 38.
Where do u come from? There might be some options of low dose selective segmental thoracic spinal anesthesia without interfering with your respiratory issue...i know few centers/mentors in Italy,Australia,India and Indonesia u could refere to. Best to you.
Ever since I first tried it, I've used the Pajunk E-Cath (CON) almost exclusively, the exception being it's unavailability. I've even resorted to simulating the E-Cath by substituting just a regular IV cannula, a throwback to the early days when the Abbocath was the norm.
Passed my first over the needle catheter a week ago, so smoothly, I am so impressed with these Pajunk devices, much better than using Tuohy e epidural cateter like we were used to do.
Great to hear. Which nerv eblock procedure and which indication? And what is the rate/bolus regimen you use? Greetings
Although I've not used CON, we have only used B brown C catheter (CTN), the above mentioned problem of catheter dislodgement during shoulder surgery for interscalene catheter can be real.
Plus stiffness can be limitation for CON.
Leak is genuine problem with CTN which might be less with CON.
Thank you for your inputs on both systems. The comments also are very helpful.
Greetings. Thank you for the feedback. Which catheters specfically do you use, actually? And do you place it in plane or out of plane and how deep beyond the needle tip? Greetings!
We place 150-200 catheters each month across multiple service lines. We prefer the over the needle from Pjaunk. We have found less catheter leakage. The ease of placement and the visualization make it a much better option for our residents. However, we recently discovered some issues with our interscalene catheters migrating from the brachial plexus with movement of the shoulder during surgery. We attributed this to the rigid sheath of the catheter. We look forward to trying the new softer more flexible catheter they have designed.
Thank you for the feedback. THat is a LOT of catheters. |WHich institution is this? And how long does it take a staff member to place and secure a catheter-over-the-needle perineural catheter?
Thank you for your detailed explanation dr Hadzic
My pleasure
Admir, I've done over 4,000 catheters since 2005 (starting before the adoption of ultrasound). I've used both CTN and CON, and i've tried many manufacturers over the years. All your pointers are correct. There's also some CTN catheters, those by Arrow with a metal coil at the end, that have been difficult to remove, because of tissue in the coil. Also some CTN that get knotted if threaded too far in. And some CTN that are so flimsy that they won't thread. And the early CON catheter that Bill Urmey developed was over a very small gauge needle that kinked if inserted without using their special clip, so you had to throw away the whole thing.
I still use both types but I'm liking the CON more now, EXCEPT for adductor canal placement, where it has a higher likelihood of dislodging. So best if you can stock both types and use appropriately, understanding all pointers you mentioned.
Hi Elie. 100% agree. In fact I have witnessed 2 Arrow catheters with the coiled stimulating wired tip being adhered to the tissue requiring an intervention for removal. Those do not have place in today's practice. Also stimulation with catheters does not make sense - it mandates additional uinnecessary steps. WHat are the blocks you use CON for mostly? Greetings!!!
@@nysoravideo nowadays workload has decreased as I ease into part time workload. I still do catheters, down to 2-3 per week only. Ideally, CON for popliteal, supraclavicular and interscalene. CTN for adductor canal.
Hi Dr. Admir, I am currently inserting around 60-80 catheters per month. Recently, I changed my practice to using Catheter Over Needle (CON), and I’ve tried both B. Braun and Pajunk products. I found that the Pajunk catheters offered better visualization under ultrasound, so I prefer to use them. However, I encountered some limitations with certain blocks that require deeper catheter advancement, such as SIFI catheters. For these cases, I still use the Catheter Through Needle (CTN) technique, while I use CON for the remaining blocks, as it helps to reduce the load on my Acute Pain Service (APS) team by minimizing leakage complications.
Very insigthful! THank you for sharing. Can you describe those limitations you encountered, we also think that for deeper blocks - different catheters are better. Greetings!!!
@@nysoravideo To overcome the challenge of catheter advancement in deep blocks like the SIFI, I’ve been using a technique that involves the B. Braun Contiplex C system. When I reach the target space, I withdraw the needle slightly and advance the catheter an additional 5-10 cm into the fascia iliaca plane. This method helps ensure that the catheter remains in the optimal position for continuous analgesia, addressing the limitations commonly seen with standard approaches.
However, with the E-Cath system, I’ve noticed that achieving the same level of advancement is nearly impossible due to the restrictive sheath, which limits the catheter’s ability to move forward beyond a certain point. This design feature of the E-Cath can be a significant drawback in cases where deeper placement is crucial for effective local anesthetic spread in the supra-inguinal fascia iliaca block.
I’d be interested to hear if others have found similar challenges or have alternative techniques to maximize the catheter placement with these systems!
Thank you doc!
My pleasure!
great info!
Glad it was helpful!
You should include information whether you receive or not any financial contributions from mentioned brands
@@Pwlkwl he said it’s a Pajunk supported video, I think it’s enough as he doesn’t need to show his bank statement 😊
@@anaesthesia666 haven’t noticed, thanks :)
It is included. This educational video was sponsored by Pajunk. However - it discusses catheter designs but it does not promote a specific catheter brand.
Good morning.
I have a question, is it possible to give you spinal anesthesia?
to put the back to sleep during scoliosis surgery? while remaining awake because I am declared inoperable because of my very low respiratory capacity, thank you for the answer.
Good morning. No. SPinal anesthesia would be a risky choice for your operation as the level of spinal anesthesia needed for your operation would most definitively interfere with the breathing. Regardless, spinal anesthesia is almost always possible.
@@nysoravideo This would be the only solution because my scoliosis is progressing and it has worsened my respiratory capacity by only 10%, so it is too risky or even impossible to intubate myself during the operation. There is a high risk that I will not wake up after the operation.
the only solution is to do spinal anesthesia to put the back to sleep while remaining awake during the operation...
Without surgery I would be dead in the next few months. I'm too young to die at 38.
Where do u come from?
There might be some options of low dose selective segmental thoracic spinal anesthesia without interfering with your respiratory issue...i know few centers/mentors in Italy,Australia,India and Indonesia u could refere to.
Best to you.