Thank you so much for sharing your experiences. I've been a nurse now for 20 years and am frequently sought out by my coworkers on my unit, and other units to initiate IV access on their otherwise difficult pokes. When asked how I do it, I always respond with warm blankets, patience, search around, back up plan, bend the needle (which always boggles a few observers), swift access, and a little bit of prayer always helps 😉 Watching your videos has helped me advance my skill to the next level. Thank you!
Until december I was a circulating nurse in the OR. I used all your videos and techniques and all worked wonders! Many were unknown so I'm always recommending your channel.
Cant wait for your book. The videos i have found ve ry useful although embarassed when people ask me where i learned and l say RUclips. Thank you for sharing your knowledge.
I've never had to do this, but another option is to ask for a Jamshidi needle and insert it into the patient's proximal humerus or proximal tibia for IO access, whichever site is more appropriate in this emergency scenario. I've never had to do that, but I've placed many EZIO-brand needles into both locations under less stressful circumstances. So I'd be comfortable using the Jamshidi emergently.
And while looking for anothert IV-access: Tilt the operating table to trendelenburg's position to increase the BP. Apart from that, in my opinion it makes sense to have a spare IV-access, especially at an obese patient. Also, laparoskopic access can cause massive bleeding from the abdominal wall, so just one 20G needle for this type of surgery would be a little less for me.
I've never had to use that vein, but in the scenario you present with an unstable patient, I'd be more confident with an external jugular approach which can often be converted to a central line using a J-wire after the circulation has been stabilized.
Pressing with the palm of the proximal hand works very well to make it more visible and even to make it more aligned, as they are normally well angled...
Try getting an assistant to occlude the cephalic vein at the top of the deltopectoral groove just inferior to the clavicle (pushing rather hard with fingers).
@@nysoravideo I think it definitely helps when I do them. I've put quite a few in with ultrasound too, and while I didn't do any measurements of vein diameter, subjectively the vein was bigger when an assistant was properly occluding the vein... I found they do need to press quite hard though, enough that an awake patient would probably have some discomfort.
I tried your bending cannula technique recently. I ended up in a very difficult situation where the cannula is in the vein but I couldn't take out the stylet out of the cannula. After a very frustrating and painfuly long struggle only I salvage the cannula at last. Anyone trying to bend cannulas please bear in mind of this before you band cannulas in the future
Yes. You can always use ultrasound. There is no rule that you should only use ultrasound for difficult IVs. I often use ultrasound to place IVs in the forearm, even when patients otherwise have good veins in the hand or cubital fossa ...I personally feel the forearm is the best place to site an IV, to minimise discomfort and complications. Consider: if you were a patient and your doctor had the same skillset as yourself, would you rather them place an IV blindly or using ultrasound guidance?
You can use an ultrasound to enter almost any vein. I have tried with superficial and deep veins and is not only effective but also fun. You just need to protect the probe with a tegaderm and use alcohol so the procedure stay aseptic (steril procedure is not obligated for peripherals).
I think I would prefer putting a central line in the femoral region without an US guidance. Probably because I am more used to it. Thank you for this demonstration though, I will try to develop this skill
@@nysoravideo Good point. It would be very challenging under surgical drapes, but not totally impossible. The cephalic vein seems to be a good alternative, as showed in this video. However I often struggle to even find it in some patients. I guess I need more practice. Thank you again.
have done tons of femorals in ED and on floor/unit. easier than cephalic plus you get a size access especially important during surgery. In OR abdo case would inform surgeon of issue and after he/she finishes chewing you out for just having 1 small peripheral IV before case can decide on femoral, neck, or SC.
Useful approach, worth to try in appropriate cases. One question in this regard: why do you insist on prompt replacement of a cephalic vein catheter? In my experience, it's rather clean and convenient location to deal with, not the first choice, but in case it had been already inserted - as good as any other peripheric vein catheter
If indeed cephalon- it’d be ok. However, this could easily be a superficial tributary to the cephalic vein. If so, pervenous infusion can be problematic
this vein will not always be visible, you can also lose precious time for this, if the situation is critical, it is safer for the patient to insert a central vein, it is better to carry out additional antibiotic prophylaxis than to waste time on inserting a peripheral vein, which is not always possible to cannulate
Without ultrasound, without stopping the OP, without removing the drapes, without properly skin disinfection... great central i.v. 🫤 Or just try this method for 20seconds... 🤷🏻♂️
Antibiotic prophylaxis doesn't mean it will stop your patient becoming septic because you inserted a central line under unsterile conditions. Also even if you are very skilled there still is a chance of arterial cannulation and pneumothorax which I really wouldn't want on top of the other problems.
Thank you so much for sharing your experiences. I've been a nurse now for 20 years and am frequently sought out by my coworkers on my unit, and other units to initiate IV access on their otherwise difficult pokes. When asked how I do it, I always respond with warm blankets, patience, search around, back up plan, bend the needle (which always boggles a few observers), swift access, and a little bit of prayer always helps 😉
Watching your videos has helped me advance my skill to the next level. Thank you!
Awesome! Thank you for your feedback! What’s your favourite trick in difficult IV’s? Greetings!
I learnt so many techniques from your videos and successfully applied them.
Great to hear!
Until december I was a circulating nurse in the OR. I used all your videos and techniques and all worked wonders! Many were unknown so I'm always recommending your channel.
Glad to hear this. Greetings!
Used it once after seeing this on your channel in an obese patient with difficult veins, worked great!
Glad to hear this! Thank you for your wonderful comment and support! Greetings!
Cant wait for your book. The videos i have found ve ry useful although embarassed when people ask me where i learned and l say RUclips. Thank you for sharing your knowledge.
Hi bigtunea4037, the book is available at amazon.com. Here is the link a.co/d/5ntlgPF
Hello Dr. Hadzic, my frequent option when I'm in a situationlike that it's to cannulate the external jugular vein, this is a life saver vein.
I've never had to do this, but another option is to ask for a Jamshidi needle and insert it into the patient's proximal humerus or proximal tibia for IO access, whichever site is more appropriate in this emergency scenario. I've never had to do that, but I've placed many EZIO-brand needles into both locations under less stressful circumstances. So I'd be comfortable using the Jamshidi emergently.
And while looking for anothert IV-access: Tilt the operating table to trendelenburg's position to increase the BP.
Apart from that, in my opinion it makes sense to have a spare IV-access, especially at an obese patient. Also, laparoskopic access can cause massive bleeding from the abdominal wall, so just one 20G needle for this type of surgery would be a little less for me.
External jugular vein cannulation is life saving in feasible situations
This has been my go to for a while after seeing one of your previous videos. Great for labs and cultures too
Glad to hear this. Greetings from NYSORA!
Cooler than the other side of the pillow. Well done as always!
Having online access to the books would be amazing! Thank you.
Please check the book here a.co/d/5ntlgPF
I am mesmerized
Bravo. Good idea
I've never had to use that vein, but in the scenario you present with an unstable patient, I'd be more confident with an external jugular approach which can often be converted to a central line using a J-wire after the circulation has been stabilized.
Anesthesiste from algeria ,thanks for your beautiful video, new information, good luck
Glad it was helpful!
👏 very nice technique. Thanks for sharing.
Pressing with the palm of the proximal hand works very well to make it more visible and even to make it more aligned, as they are normally well angled...
Try getting an assistant to occlude the cephalic vein at the top of the deltopectoral groove just inferior to the clavicle (pushing rather hard with fingers).
Great tip! How often does this work? Greetings!
@@nysoravideo I think it definitely helps when I do them. I've put quite a few in with ultrasound too, and while I didn't do any measurements of vein diameter, subjectively the vein was bigger when an assistant was properly occluding the vein...
I found they do need to press quite hard though, enough that an awake patient would probably have some discomfort.
I’ve heard people used frontal (forehead) vein if visible, foot veins or external jugular for quick IV access.
I tried your bending cannula technique recently. I ended up in a very difficult situation where the cannula is in the vein but I couldn't take out the stylet out of the cannula. After a very frustrating and painfuly long struggle only I salvage the cannula at last. Anyone trying to bend cannulas please bear in mind of this before you band cannulas in the future
Sell the book in Spanish version. Please
When we have another skin colour that make difficult to identify the vein in this site , can we use the ultrasound ???
If you want to use the ultrasound you should use often, so you get use to it
Yes. You can always use ultrasound. There is no rule that you should only use ultrasound for difficult IVs.
I often use ultrasound to place IVs in the forearm, even when patients otherwise have good veins in the hand or cubital fossa ...I personally feel the forearm is the best place to site an IV, to minimise discomfort and complications.
Consider: if you were a patient and your doctor had the same skillset as yourself, would you rather them place an IV blindly or using ultrasound guidance?
You can use an ultrasound to enter almost any vein. I have tried with superficial and deep veins and is not only effective but also fun. You just need to protect the probe with a tegaderm and use alcohol so the procedure stay aseptic (steril procedure is not obligated for peripherals).
I think I would prefer putting a central line in the femoral region without an US guidance. Probably because I am more used to it. Thank you for this demonstration though, I will try to develop this skill
Good idea, but tough to do under surgical drapes during abdominal surgery.how would you do it? Greetings?
@@nysoravideo Good point. It would be very challenging under surgical drapes, but not totally impossible. The cephalic vein seems to be a good alternative, as showed in this video. However I often struggle to even find it in some patients. I guess I need more practice. Thank you again.
have done tons of femorals in ED and on floor/unit. easier than cephalic plus you get a size access especially important during surgery. In OR abdo case would inform surgeon of issue and after he/she finishes chewing you out for just having 1 small peripheral IV before case can decide on femoral, neck, or SC.
Is this acceptable in patients who have a restricted upper extremity, such as those who have had lymph node dissection from breast cancer surgery?
Hmm was that really the cephalic vein?
Useful approach, worth to try in appropriate cases. One question in this regard: why do you insist on prompt replacement of a cephalic vein catheter? In my experience, it's rather clean and convenient location to deal with, not the first choice, but in case it had been already inserted - as good as any other peripheric vein catheter
If indeed cephalon- it’d be ok. However, this could easily be a superficial tributary to the cephalic vein. If so, pervenous infusion can be problematic
this vein will not always be visible, you can also lose precious time for this, if the situation is critical, it is safer for the patient to insert a central vein, it is better to carry out additional antibiotic prophylaxis than to waste time on inserting a peripheral vein, which is not always possible to cannulate
put the subclavian vein for 10 seconds, without ultrasound, its my choice
Without ultrasound, without stopping the OP, without removing the drapes, without properly skin disinfection... great central i.v. 🫤
Or just try this method for 20seconds... 🤷🏻♂️
@@kaybartel627810 seconds is not a difference.
Antibiotic prophylaxis doesn't mean it will stop your patient becoming septic because you inserted a central line under unsterile conditions. Also even if you are very skilled there still is a chance of arterial cannulation and pneumothorax which I really wouldn't want on top of the other problems.
People seem to think that adding antibiotics can compensate for absolutely shitty Sterile technique
That vein is visible only in white skinned people but not in dark or brown skinned people..
Thanks for a great option, but…you never start anesthesia/surgery in an obese patient like this with only one iv cannula. Always two…just in case.
I go there all the time.
Is nano particle, mrna in local anestetic?
Thanks. I wont your book.
Please check the book here a.co/d/fWRPl3G