Just started watching your videos! I love what your doing!! Our daughter got diagnosed with cancer stage 4, high risk neuroblastoma at 2 years old. She has had a PICC line, tunneled central line with double lumens and a port placed for her cancer treatments. The PICC line was temporary since she had tested positive for RSV only a few days before we got her cancer diagnosis. Her oncologist wanted her to be able to start getting chemotherapy as soon as possible. A port and the central line were placed the next month. She is currently cancer free!
I am in nursing school and I found this video extremely helpful! It simplified what my textbook says and what my professor spoke hours on into a quick 20 minute video. The visuals within the video were also very helpful. Thank you for making this video!
I'm a new grad in critical care and just discovered your channel. It's very helpful! I'm finding there is a lot that was not covered (or barely covered) in nursing school that I'm encountering on the floor and your videos help me understand the concepts better than the explanation done on the floor or while charting. Thank you!!!
From a medical student doing a cancer care block, I found this so useful for understanding the different types of central lines used and it was an incredibly clear and concise explanation. Excellent teaching, thank you.
even though I am not an icu doctor and I don't do these central lines but I do watch them do every single day when I have operations . its extra knowledge ! thank you
I am simply a patient with an interest in central lines (as I’ve had them for over 13 years now) and I have to say, THANK YOU for teaching that scrubbing of the access line after a swab is needed.
I am a new grad nurse starting in the ICU! I have been an ICU tech for almost two years! This is so informational and helpful. Thank you so much. I will be listening to your vidoes! Subscribed!
Thank you sooo kindly. I’ve been awaiting for your content for better part of a month or two (at least that’s what it feels like). Good to have you back. Hope North Carolina life is treating you well my friend.
Amazingly taught! I am a new grad at cardio hosp, what you taught has made sense instantly, vs nursing school and my preceptor in that sense! Thank you!!!!!!
Thank you very much, from an emergency nurse who is having to care for complicated ICU pts for longer and longer in the emergency department due to access block.
I love the videos!!! Super helpful for a nursing student like myself. It helps going into clinicals and seeing this beforehand. Now I don’t have to ask a thousand questions and seem incompetent
I've had a PICC (peripherally inserted central catheter) 3 times so far for administering antibiotics, high dose for up to 6 - 8 weeks. The catheter is inserted in the vena basilica, vena cephalica or the vena brachialis. Using a PICC is a minor procedure under local anesthesia.
Im a icu tech and I know nothing about the icu. I left from being a school teacher to this. I just feel so lost and confused but I’m willing to learn. It just seems like so much.
I’m 25 and chronically Ill. I currently have a port and am accessed every day. Im switching to a Hickman and trying to figure out which ones fit my needs and what my hospital carries. Thank you for this video!
I am having the roughest time trying to distinguish the difference b/t tunneled and non-tunneled. What determines the difference b/t the two? Is it the treatment, or location of insertion? Or are they defined by the line itself (e.g. PICC).
Have experienced central line as patient thru jugular, banging Amiodarone into the vena cava. On insertion the doc had a student with him. I was conscious with a numbing agent, I heard him say 'now we do a transverse section of the vein' then I felt my neck being cut. I just did relaxation techniques and thought 'he's a doctor, he knows what he's doing, right?' That was quite a weird experience though, getting your jugular cut. Anyway about 20 hours later a nurse came to take out the line. He fiddled about for over 15 minutes and couldnt get the catch, it hurt and I could see he was sweating, I finally said listen mate, this is not the most fun I have ever had, can you go and get someone who has done this more often than you to do this? He was probably quite relieved and a big bald geezer came in and had the line out in maybe 20 seconds. He was an experienced nurse, in fact he had a week to go until retirement!
Question: I work nights on a step-down unit. The other night I had an ED admit w/ anemia R/T GI bleed. Pt had 1 unit PRBC in ED, but was still 7.0 Hgb upon admission, and was ordered 2nd unit. Pt had 1 PIV in AC, which was lost upon arrival. Pt’s veins were deep, tiny, and fragile. I attempted several IVs. Then recruited the best IV wizards on my unit. Then asked other units to send their best, including ICU RNs, then Trauma team with US guided placement. Everything failed, and midline was only possible with IV access team in AM. At midnight Hgb now 6.6, but Pt was HDS otherwise, with VSS. I was advocating for request for ICU MD to place a CVC, but my charge nurse and covering MD didn’t want to go that route d/t no other indication for CVC. ED RNs can place an EJ, but (for reasons I’m not too clear about) it’s against floor policy to have ED RNs come to our unit to place an EJ. So, the plan was to closely monitor, and if Pt became symptomatic or no longer HDS, then we would do an IO to give PRBC. But if Pt HDS throughout night, we could get midline in AM with IV access team and give PRBC then. Thankfully, Pt was able to make it till AM (Hgb was 5.8 in AM, but we were able to transfuse w/ midline shortly after H&H resulted). My question is this: would it have been better to go with my proposal and get a CVC at midnight? Or, was the plan we went with-wait for AM and place an IO if Pt became symptomatic-the better option? Or, were there other possible venous access options that we overlooked? Thanks so much for all your videos! I’m a step-down RN now, but I aspire to transition to ICU eventually, and I soak up all your wonderful tutorials!
Difficult access is rarely and indication due to risk of procedure and infection. They are really cracking down on central line associated bloodstream infections. In the ICU we have to pull them as soon as they are no longer indicated for pressors, monitoring or TPN.
I would like to point out that at 5:30 you mention CVCs being ideal for large volumes of fluids due to "increased flow". However, I''m fairly certain that, by virtue of the catheter being larger, the flow is not as fast as you might think. For MTP or large volume fluid resuscitation, I'm fairly certain that you achieve the "fastest" flow with large bore 16g or 18g PIVs.
Depends of the CVC you use. I talk about this more starting around 14:08. You can achieve faster flows than even a 16g with large bore lines. I believe I also cover this in the lesson on MTP that I did as well.
My grandma was put on hemo dialysis a year ago and had a loop graft put it in her lower right arm but it got infected with mrsa after a month or two. They then put in a CVC on her neck and she’s been using it for the past 7 months. We just went in for surgery to get a AV Graft put in her upper left arm and after the surgery her hand became ice cold and numb so we took her to the ER. They admitted her and the next day the surgeon reached out to get my decision on the next step. He said it wouldn’t be a good idea to leave it as is and hope because if it gets worse when they use the graft it could lead to full loss of motor function in her hand. So the two options he gave me was one to remove the graft fully and continue using the CVC until her arm heals and talk about getting another one done. The other option was for him to go into the incision and try to bring it higher to another vein to maybe increase blood flow to the hands but he said he can’t really predict what will happen. It could cause the graft to stop working and it’ll have to be removed after anyway. So we went ahead with removing the graft completely and gonna wait and see what our next options are. My question is how long can someone have a CVC in for HD and what’s the main causes of failure besides infection? She’s had it for 7 months and we’re concerned if she can’t get another AV Graft in her arm what would we do if the CVC gets infected or something. She only weighs 95lbs and her veins are very small which is the reason they are doing grafts instead of fistulas.
Hello, this was really helpful, my questions are, can heparin be use to central line that clot and can one force the infusion of of the flush when it is blocked
Thank you so much 🙏🏻, Very nice lecture, nicely explain all of things and every things understood . Can you please make video on adrenaline drug , Thank you so much 😊
Great video! I am wondering if you have a list of meds that are vesicants and are recommended to be given via central lines? As a cath lab RN I would be helpful to know.
You mentioned trying to avoid TPN, Would you explain why? I just read an article about ICU patients having significantly better outcomes if nutrition of some kind begins within the first 24 hours
Nutrition - yes but through an enteral means is preferable over parenteral due to refeeding syndrome, infection, hepatic problems, electrolyte imbalances, etc. TPN and PPN require closer monitoring with frequent evaluations for the necessity of it and are associated with increased costs. Enteral feeding through OGT/NGT or PEG are preferable and are more associated with more favorable outcomes if the patient is not on high dose pressors, lipid-based drugs such as Propofol and Cleviprex and paralytics.
k v beat me too it. Definitely important to start nutrition as soon as possible. Sometimes that does mean parenteral nutrition, but if possible we try to avoid it as it has a host of issues that can come up, infection probably being our biggest complication and frequent concern.
I really appreciated this video. Today I was wondering what the differences were between the hemodialysis catheter and the triple lumen. I had a patient who is in need of TPN but wasn’t able to though that hemodialysis catheter (Trialysis) had a pigtail.
The dialysis catheter lumens are much larger than the regular central line. As for using the trialysis catheter there, we ideally don't want to use that port, as when therapy is running (HD or CRRT), there is the risk that what we are infusing could get pulled into the circuit and dialyzed off. So in cases like this, we definitely need a dedicated access for that stuff and just have the trailysis line as an energy line if needed.
Hello Mr. Eddie, I am big fan of your channel, definitely useful information, thank you and I can't not wait for you to talk about difficult airway management. Ps: I'm sure is going to be epic
I had a central line (svc) and it blew. They didn't get it all out and it eventually wrapped my heart and stuck in my left vent. It's since disappeared. I've got a port. There's 2 different ports - ones a power port for mri dyes, etc and mine is a reg portfolio IVs and labs. Make sure ppl know which you have bc ports can be blown, too.
Funny thing is I have a central line. I had it since I was a baby and now I'm 19. I have a single lumen line and just been living life like this. Now of days I'm doing really good and have been staying healthy. I just wanted to thank you for making this video it was really informative even for me.
@@marshevangeems7360 If anyone drops anything on the floor and are going to hook you up tell them no. You can get really sick if this happens. Um remember to do 15 seconds alcohol wipes...Just be safe...
Hey man, I’m 22 years old and just got a CVC put in and kinda stressed out. Do you still manage to have full mobility of your body and live a normal lifestyle? Thanks
@@Zemo1029 Hi Zemo1029, To answer your question Yes I do. I think It mostly matters on where they place the Line. For me it's placed in my lower left subclavian, So I have a lot of range in movement. But I'm assuming for you it would be around the same area. I can do anything any other person can do. You do need to be careful not to hurt the line and have good Sterile Technique when accessing the Line. Like alcohol wipe for 15 seconds wearing gloves when accessing the line. A very Import tip Don't hook up anything to yourself if it hit's the floor. Throw it away imedentlly, Trust me I've had some bad nurses that hooked stuff up that hit the floor, That's just a Line Infection waiting to happen. But If your careful with your Line and know really good Sterille Technique it's fine. Other than that it's just regular life but with a Centrel Line. Also I'm a year younger then you! Just thought that was funny. But Yeah I've lived with my Line for all my life pretty much and I've lived happily and healthfully. Right now I'm currently working on evenglly getting off TPN which is pretty hard but I think I can get there. I've been though a lot of hardships in my life but I survive though the tough times with a smile on my face. What I'm trying to say is you really don't have to worry and it'll be fine. If you have anyone questions please let me know.
@@Zemo1029 Hi Zemo 1029, To answer your question for me I still have a normal life style. My central line is placed in my left sibclaven so I have a lot of range in movement. I'm pretty sure it matters where your line is placed but even so, You'll still have a normal life you just gotta take care of that Central Line. You should learn really good Sterile Technique. The basics like Alchol wipe for 15 seconds, If any thing that you were gonna hook up hits the floor or get's contaminated you gotta throw it away or in the contaminated sences replace it. Wear Gloves anytime you access the Line. Just keep your Line Really Clean. Oh and listen to your doctors and nurses orders. Trust me I've had nurses that dropped sallening on the floor and go to hook me up...That's really not good cause it would give me line infections, But I survived everyone of them. Even with the Centreal Line I still live a normal life style, I go to collage, hangout with friends, edit videos, make sort films, and play video games, and read comics. So I have a pretty normal life all things considered. While I am a nerdy guy so I'm not sure how normal you could call it but eh. XD But You'll be fine and if you have any other questions please let me know.
Thank you for all the useful information, I work in a trauma ICU and we have been using IV paralytics more often. can you include Train of four education? Thank you
If I want to pull out the line at home how would I got about that? I’ve had a heart transplant and I’m at the end of life and my doctor doesn’t want to take it out even when I refuse medical treatment. This has been an ongoing battle and I have both cellular and antibody rejection. I’m truly at my wits end.
Hickman/broviac line fo' lyfe in the SC. Iv antihistamine dependent patient here who's been dependent on a CVC q2 for the past 4 years. Thankful it's an option, but damnn is CLABSI scary AF.
Good question. So when that happens, its going to have to come out, but depending where it is may make it complicated as strong pressure will need to be help for 5-10 minutes after pulling it out. Depending on the size of the catheter and the artery that was accessed, it may require a consult to vascular to remove safely. Fortunately, this is pretty rare, especially now a days when U/S is used all the time.
Is there specific protocol for which lines the nurse can admin meds vs draw for labs ? Also I’ve noticed that some patients with a hemodialysis Cath who come back from dialysis will have their lines wrapped up “like don’t touch them”. Why is that if they need to be flushed ?
Its all based on your facility policies and what they allow. And for the HD lines, typically, some places pack those with heparin or citrate when not in use, which is often why they say not to touch them. Its important that if they are dwelling with that, that it is aspirated out appropriately before being used.
Is this basically a poth a cath?? (Not connected means n lines outside the body, connected can be with fluids due to kudneydefficiency, dysautonomia, and loads of other illnesses)
Hello, very thank you for the video. However, do you set the youtube autotranslate subtitle option into vietnam? Very confused how to change back to English autotranslate subtitle,.
@@ICUAdvantage OMG you replied. I'm starstruck. I'm an RN binge watching your videos for a placement exam to work in an acute setting after a long time being away from it. I sure am glad I came across your channel. You're a godsend! Please keep up the amazing work! 🙂
@@jhonrydc110 haha man just another fellow nurse out here. Nothing special. Just trying to help educate. Really glad you enjoy the videos and find them helpful. A LOT of videos these days to binge haha.
So I have a tunneled central line (Hickman) but I’m allergic to the skin prep so my question is since I can’t use the bio patch should I be doing a dressing change more often than every 7 days? And if so how often? I just use alcohol and stat lock and tagaderm and had remained infection free for 13 months. But could possibly doing a dressing change every 3 days be preferable? I read somewhere that was protocol if the bio patch isn’t present. But sadly my team though extremely caring aren’t the most knowledgeable especially on all of my conditions and the use of a central line so I need to educate myself. Thanks 😊 I’m on TPN by the way. 😉🥰
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Good and highly usefull for nurses
Just started watching your videos! I love what your doing!! Our daughter got diagnosed with cancer stage 4, high risk neuroblastoma at 2 years old. She has had a PICC line, tunneled central line with double lumens and a port placed for her cancer treatments. The PICC line was temporary since she had tested positive for RSV only a few days before we got her cancer diagnosis. Her oncologist wanted her to be able to start getting chemotherapy as soon as possible. A port and the central line were placed the next month. She is currently cancer free!
So sorry to hear you guys have had to go through this but AMAZING to hear she is cancer free! That is so awesome!!!
Wow may God be praised for her healing
God bless her with Good health & future
So happy for you
May God continue to bless your baby girl😊🙏🙏
Learned more during your videos than hours my nursing instructors did in 2 years
Wow, glad I was able to help!
I'm a new grad SICU nurse, and I am relying very much on your videos throughout my orientation. Thank you so much for doing this!!!
Congrats on the new SICU job Katie! Truly my pleasure. Glad you are finding them helpful for you.
Hi how’s it going in the SICU. I’m currently on a Stepdown Cardiac unit with plans to transfer to our CVICU soon!
Same here!
Meeee too ! I'm new to the SICU !! After 12 years on medsurg tele and I find these videos valuable!!! Thanks Eddie ! 😊
new MICU/SICU nurse, from Ortho/Trauma. Also enjoying the videos and help
I am in nursing school and I found this video extremely helpful! It simplified what my textbook says and what my professor spoke hours on into a quick 20 minute video. The visuals within the video were also very helpful. Thank you for making this video!
So great to hear this Ashley! Thanks so much for the comment
I'm a new grad in critical care and just discovered your channel. It's very helpful! I'm finding there is a lot that was not covered (or barely covered) in nursing school that I'm encountering on the floor and your videos help me understand the concepts better than the explanation done on the floor or while charting. Thank you!!!
How have you acclimated? I'm in a similar position to you when you initially wrote this, do you have any advice?
Awesome lesson! I've worked with central lines for years but this was a GREAT refresher and even taught me some things I didn't know!
Very cool! Thats why I love making videos for this channel as I remember things I forgot or even learn some new things myself!
Maam goodevening how to declogged central venous cath properely same with intra jugular vein cath in hemodialsysis
From a medical student doing a cancer care block, I found this so useful for understanding the different types of central lines used and it was an incredibly clear and concise explanation. Excellent teaching, thank you.
Appreciate that and glad you found it helpful!
even though I am not an icu doctor and I don't do these central lines but I do watch them do every single day when I have operations . its extra knowledge ! thank you
Yes, done a lot in the OR! Would often request to have it done when we have a patient going there and they need one.
I am simply a patient with an interest in central lines (as I’ve had them for over 13 years now) and I have to say, THANK YOU for teaching that scrubbing of the access line after a swab is needed.
Im transitioning from ER to ICU so I can apply for CRNA school, and your channel has taught me SO much! Thank you and keep up the great work 🎉
I just switched from tele to Cvicu for the same reason 🤗
I am a new grad nurse starting in the ICU!
I have been an ICU tech for almost two years!
This is so informational and helpful. Thank you so much. I will be listening to your vidoes!
Subscribed!
Thank you sooo kindly. I’ve been awaiting for your content for better part of a month or two (at least that’s what it feels like). Good to have you back. Hope North Carolina life is treating you well my friend.
Dialysis Patients have CVCs as well not just ICU Patients. This is really informative and I enjoyed learning about it.
Yup absolutely! They certainly can be found at all levels. Just very common in ICU :)
Amazingly taught! I am a new grad at cardio hosp, what you taught has made sense instantly, vs nursing school and my preceptor in that sense! Thank you!!!!!!
Thank you- it’s so valuable to have lessons that are thoroughly professional.
cant explain how u make everything so easy to understand. As a developing nurse, i'm loving this new channel discovery, thank you! keep it up
Really glad to hear you think so! I've got a ton of stuff already and a lot more planned still
As a physiotherapy student, I find this video very helpful. Videos this long usually gets boring along the line, but this was a masterpiece.
Awesome information. Thanks for the multi-lumen education. My ICU rotation at UNC definitely went smoother thanks to you videos!
Sweet! Really glad to hear I was able to help in some way. UNC is a beautiful campus!
Fantastic 👏🏾 thank u for the information about laying pts on their left side with suspected air embolism. I can’t believe I didn’t know this.
Its not something thats taught often I've seen! Glad you enjoyed it 😊
Thank you very much, from an emergency nurse who is having to care for complicated ICU pts for longer and longer in the emergency department due to access block.
A refresher is always nice. Thanks for the short and sweet lecture 👍🏾
Awesome! Glad you liked it
I love the videos!!! Super helpful for a nursing student like myself. It helps going into clinicals and seeing this beforehand. Now I don’t have to ask a thousand questions and seem incompetent
Awesome. Yeah its great to not go in completely blind! Glad to be able to help.
INFREAKING CREDIBLE VIDEO! so so so so happy for this content! helping so much with my ICU journey
Wow, thank you SO much Kadie! Puts a smile on my face to hear this. Truly happy to help!
Outstanding refresher!
Awesome. Glad you liked it!
Thank you so much for your video. I learned a lot about these lines.
excellent information and explained so well - thank you!
Great video!
I've seen them check ABGs on an attempted IJ to check if it was in the artery instead.
Very well explained and detailed. Thank you.🙂🙂🙂
That was fantastic- you are such a blessing! Thank you.
Really appreciate that Jerica!
Man this may cover first semester at MAC Wowsa. Detailed and love it. Thank you.
So this is all I needed, thank you so much.
You're so welcome!
I've had a PICC (peripherally inserted central catheter) 3 times so far for administering antibiotics, high dose for up to 6 - 8 weeks. The catheter is inserted in the vena basilica, vena cephalica or the vena brachialis. Using a PICC is a minor procedure under local anesthesia.
Im a icu tech and I know nothing about the icu. I left from being a school teacher to this. I just feel so lost and confused but I’m willing to learn. It just seems like so much.
This video is so helpful! Thank you!
Glad to hear it. Youre welcome!
Came just in time....thanks ICU ADVANTAGE.
Love it when it works out like that! YW!
Great refresher going back to ICU
Welcome back!
Very conclusive,thank you very much
I’m 25 and chronically Ill. I currently have a port and am accessed every day. Im switching to a Hickman and trying to figure out which ones fit my needs and what my hospital carries. Thank you for this video!
Absolutely loved this video
Very helpful. I’ve worked in a clinic when I was a new grad rn and now I’m at the hospital and forgot a lot of things. This helps so much.
Congrats on the hospital gig and glad you found the video helpful Danielle!
New subscriber here.. so easy to understand… thank you for this, and you explain well too and some rationale.
I am having the roughest time trying to distinguish the difference b/t tunneled and non-tunneled. What determines the difference b/t the two? Is it the treatment, or location of insertion? Or are they defined by the line itself (e.g. PICC).
Have experienced central line as patient thru jugular, banging Amiodarone into the vena cava. On insertion the doc had a student with him. I was conscious with a numbing agent, I heard him say 'now we do a transverse section of the vein' then I felt my neck being cut. I just did relaxation techniques and thought 'he's a doctor, he knows what he's doing, right?' That was quite a weird experience though, getting your jugular cut. Anyway about 20 hours later a nurse came to take out the line. He fiddled about for over 15 minutes and couldnt get the catch, it hurt and I could see he was sweating, I finally said listen mate, this is not the most fun I have ever had, can you go and get someone who has done this more often than you to do this? He was probably quite relieved and a big bald geezer came in and had the line out in maybe 20 seconds. He was an experienced nurse, in fact he had a week to go until retirement!
Wooowww kinda nasty experience but glad you kept calm. Hopefully you recovered from you condition❤❤.
Question: I work nights on a step-down unit. The other night I had an ED admit w/ anemia R/T GI bleed. Pt had 1 unit PRBC in ED, but was still 7.0 Hgb upon admission, and was ordered 2nd unit. Pt had 1 PIV in AC, which was lost upon arrival. Pt’s veins were deep, tiny, and fragile. I attempted several IVs. Then recruited the best IV wizards on my unit. Then asked other units to send their best, including ICU RNs, then Trauma team with US guided placement. Everything failed, and midline was only possible with IV access team in AM.
At midnight Hgb now 6.6, but Pt was HDS otherwise, with VSS. I was advocating for request for ICU MD to place a CVC, but my charge nurse and covering MD didn’t want to go that route d/t no other indication for CVC. ED RNs can place an EJ, but (for reasons I’m not too clear about) it’s against floor policy to have ED RNs come to our unit to place an EJ. So, the plan was to closely monitor, and if Pt became symptomatic or no longer HDS, then we would do an IO to give PRBC. But if Pt HDS throughout night, we could get midline in AM with IV access team and give PRBC then.
Thankfully, Pt was able to make it till AM (Hgb was 5.8 in AM, but we were able to transfuse w/ midline shortly after H&H resulted). My question is this: would it have been better to go with my proposal and get a CVC at midnight? Or, was the plan we went with-wait for AM and place an IO if Pt became symptomatic-the better option? Or, were there other possible venous access options that we overlooked?
Thanks so much for all your videos! I’m a step-down RN now, but I aspire to transition to ICU eventually, and I soak up all your wonderful tutorials!
Difficult access is rarely and indication due to risk of procedure and infection. They are really cracking down on central line associated bloodstream infections. In the ICU we have to pull them as soon as they are no longer indicated for pressors, monitoring or TPN.
Fantastic and super helpful video. Thank you!
You're very welcome! Appreciate the awesome comment Ben
Really appreciate all your videos. Thanks
Excellent informative content here! Thank you for creating this!
Really glad you enjoyed it and thanks for leaving a comment.
Love it. your explanations are amazing!. thanks for these great videos.
your lecture is amazing! Thank you!
Wow, thank you so much!
Great job. I learnt a lot
Very helpful video, thank you!
Of course it’s very useful ❤️❤️🥹
THANK U!!! Helped so much
Very impressive and simple lesson. Thanks a lot
Sweet baby jesus I am confused... good thing I can watch this over and over
I would like to point out that at 5:30 you mention CVCs being ideal for large volumes of fluids due to "increased flow". However, I''m fairly certain that, by virtue of the catheter being larger, the flow is not as fast as you might think. For MTP or large volume fluid resuscitation, I'm fairly certain that you achieve the "fastest" flow with large bore 16g or 18g PIVs.
Depends of the CVC you use. I talk about this more starting around 14:08. You can achieve faster flows than even a 16g with large bore lines. I believe I also cover this in the lesson on MTP that I did as well.
Amazing video - ! thank you for sharing
Very helpful,Godbless your channel🤍
My grandma was put on hemo dialysis a year ago and had a loop graft put it in her lower right arm but it got infected with mrsa after a month or two. They then put in a CVC on her neck and she’s been using it for the past 7 months. We just went in for surgery to get a AV Graft put in her upper left arm and after the surgery her hand became ice cold and numb so we took her to the ER. They admitted her and the next day the surgeon reached out to get my decision on the next step. He said it wouldn’t be a good idea to leave it as is and hope because if it gets worse when they use the graft it could lead to full loss of motor function in her hand. So the two options he gave me was one to remove the graft fully and continue using the CVC until her arm heals and talk about getting another one done. The other option was for him to go into the incision and try to bring it higher to another vein to maybe increase blood flow to the hands but he said he can’t really predict what will happen. It could cause the graft to stop working and it’ll have to be removed after anyway. So we went ahead with removing the graft completely and gonna wait and see what our next options are.
My question is how long can someone have a CVC in for HD and what’s the main causes of failure besides infection? She’s had it for 7 months and we’re concerned if she can’t get another AV Graft in her arm what would we do if the CVC gets infected or something. She only weighs 95lbs and her veins are very small which is the reason they are doing grafts instead of fistulas.
Hello, this was really helpful, my questions are, can heparin be use to central line that clot and can one force the infusion of of the flush when it is blocked
Awesome video 👏
Thank you so much 🙏🏻,
Very nice lecture, nicely explain all of things and every things understood . Can you please make video on adrenaline drug ,
Thank you so much 😊
Great video! I am wondering if you have a list of meds that are vesicants and are recommended to be given via central lines? As a cath lab RN I would be helpful to know.
Glad you liked it. I don't have a list, but would be a good resource.
You mentioned trying to avoid TPN, Would you explain why? I just read an article about ICU patients having significantly better outcomes if nutrition of some kind begins within the first 24 hours
Nutrition - yes but through an enteral means is preferable over parenteral due to refeeding syndrome, infection, hepatic problems, electrolyte imbalances, etc.
TPN and PPN require closer monitoring with frequent evaluations for the necessity of it and are associated with increased costs.
Enteral feeding through OGT/NGT or PEG are preferable and are more associated with more favorable outcomes if the patient is not on high dose pressors, lipid-based drugs such as Propofol and Cleviprex and paralytics.
k v beat me too it. Definitely important to start nutrition as soon as possible. Sometimes that does mean parenteral nutrition, but if possible we try to avoid it as it has a host of issues that can come up, infection probably being our biggest complication and frequent concern.
TPN is the last nutricion source there is...
I really appreciated this video. Today I was wondering what the differences were between the hemodialysis catheter and the triple lumen. I had a patient who is in need of TPN but wasn’t able to though that hemodialysis catheter (Trialysis) had a pigtail.
The dialysis catheter lumens are much larger than the regular central line.
As for using the trialysis catheter there, we ideally don't want to use that port, as when therapy is running (HD or CRRT), there is the risk that what we are infusing could get pulled into the circuit and dialyzed off.
So in cases like this, we definitely need a dedicated access for that stuff and just have the trailysis line as an energy line if needed.
Thank you so much.. Very clear and well explained... Asante ❤️❤️
Hello Mr. Eddie, I am big fan of your channel, definitely useful information, thank you and I can't not wait for you to talk about difficult airway management.
Ps:
I'm sure is going to be epic
I had a central line (svc) and it blew. They didn't get it all out and it eventually wrapped my heart and stuck in my left vent. It's since disappeared. I've got a port. There's 2 different ports - ones a power port for mri dyes, etc and mine is a reg portfolio IVs and labs. Make sure ppl know which you have bc ports can be blown, too.
I had septic shock and had a central line by my neck. I have a very small scar not noticeable but it reminds me how lucky I am that I survived it.
Glad to hear you survived! Don't ever forget it and appreciate all life has to offer!
What is the difference between a tunneled and non-tunneled has far as how they are inserted and where the lumens sit?
Thank you for this🤟
Funny thing is I have a central line. I had it since I was a baby and now I'm 19. I have a single lumen line and just been living life like this. Now of days I'm doing really good and have been staying healthy.
I just wanted to thank you for making this video it was really informative even for me.
I have to get a central line. I'm quite scared. What do you avoid doing with your central line?
@@marshevangeems7360 If anyone drops anything on the floor and are going to hook you up tell them no. You can get really sick if this happens. Um remember to do 15 seconds alcohol wipes...Just be safe...
Hey man, I’m 22 years old and just got a CVC put in and kinda stressed out. Do you still manage to have full mobility of your body and live a normal lifestyle? Thanks
@@Zemo1029 Hi Zemo1029,
To answer your question Yes I do. I think It mostly matters on where they place the Line. For me it's placed in my lower left subclavian, So I have a lot of range in movement. But I'm assuming for you it would be around the same area.
I can do anything any other person can do. You do need to be careful not to hurt the line and have good Sterile Technique when accessing the Line. Like alcohol wipe for 15 seconds wearing gloves when accessing the line. A very Import tip Don't hook up anything to yourself if it hit's the floor. Throw it away imedentlly, Trust me I've had some bad nurses that hooked stuff up that hit the floor, That's just a Line Infection waiting to happen.
But If your careful with your Line and know really good Sterille Technique it's fine. Other than that it's just regular life but with a Centrel Line.
Also I'm a year younger then you! Just thought that was funny. But Yeah I've lived with my Line for all my life pretty much and I've lived happily and healthfully.
Right now I'm currently working on evenglly getting off TPN which is pretty hard but I think I can get there.
I've been though a lot of hardships in my life but I survive though the tough times with a smile on my face.
What I'm trying to say is you really don't have to worry and it'll be fine. If you have anyone questions please let me know.
@@Zemo1029 Hi Zemo 1029,
To answer your question for me I still have a normal life style. My central line is placed in my left sibclaven so I have a lot of range in movement. I'm pretty sure it matters where your line is placed but even so, You'll still have a normal life you just gotta take care of that Central Line.
You should learn really good Sterile Technique. The basics like Alchol wipe for 15 seconds, If any thing that you were gonna hook up hits the floor or get's contaminated you gotta throw it away or in the contaminated sences replace it. Wear Gloves anytime you access the Line. Just keep your Line Really Clean. Oh and listen to your doctors and nurses orders. Trust me I've had nurses that dropped sallening on the floor and go to hook me up...That's really not good cause it would give me line infections, But I survived everyone of them.
Even with the Centreal Line I still live a normal life style, I go to collage, hangout with friends, edit videos, make sort films, and play video games, and read comics. So I have a pretty normal life all things considered. While I am a nerdy guy so I'm not sure how normal you could call it but eh. XD
But You'll be fine and if you have any other questions please let me know.
Very informable...tnks a lot..all the videos are with complete information in simple way...keep going..👍
Thank you and happy to hear you enjoy the videos!
Thank you for all the useful information, I work in a trauma ICU and we have been using IV paralytics more often. can you include Train of four education?
Thank you
Just finished recording this one today actually! Look for it next week ;)
Super informative!
Glad to hear this!
If I want to pull out the line at home how would I got about that? I’ve had a heart transplant and I’m at the end of life and my doctor doesn’t want to take it out even when I refuse medical treatment. This has been an ongoing battle and I have both cellular and antibody rejection. I’m truly at my wits end.
Hickman/broviac line fo' lyfe in the SC. Iv antihistamine dependent patient here who's been dependent on a CVC q2 for the past 4 years. Thankful it's an option, but damnn is CLABSI scary AF.
Definitely can be, hence the need for all the clean techniques! But certainly manageable and preventable.
You are amazing , thank you so much .
You are too kind but thank you!
EXTRAORDINARY!!!!!
Thanks for yet another educational video. Question: what if the CVL is accidentally inserted into the artery like the carotid for instance?
Good question. So when that happens, its going to have to come out, but depending where it is may make it complicated as strong pressure will need to be help for 5-10 minutes after pulling it out. Depending on the size of the catheter and the artery that was accessed, it may require a consult to vascular to remove safely. Fortunately, this is pretty rare, especially now a days when U/S is used all the time.
At my hospital if the pt has a central line we do cultures from the line & peripherally too.
Oh yeah we almost never do from the line unless we really have to!
Is there specific protocol for which lines the nurse can admin meds vs draw for labs ?
Also I’ve noticed that some patients with a hemodialysis Cath who come back from dialysis will have their lines wrapped up “like don’t touch them”. Why is that if they need to be flushed ?
Its all based on your facility policies and what they allow. And for the HD lines, typically, some places pack those with heparin or citrate when not in use, which is often why they say not to touch them. Its important that if they are dwelling with that, that it is aspirated out appropriately before being used.
Great content
Thank you for this! 🙏🏼
You're welcome!
Are there alternatives to the biopatch for patients who are allergic to CHG?
Yes. Silver impregnated disc is 1 option that comes to mind
Love the way u teaches us... I have a request is it any possible that you make a video on central line measurement ...
Happy to hear that. And are you referring to measurement for what length to use when placing?
@@ICUAdvantageyes
@@lazy_titan4307 I don't know if a whole video could be dedicated to that. I may keep it in mind for any future lessons on central lines
@@ICUAdvantage thanks ... ☺️☺️
Is this basically a poth a cath?? (Not connected means n lines outside the body, connected can be with fluids due to kudneydefficiency, dysautonomia, and loads of other illnesses)
Have you considered making study cards/badge buddies for your info? I’d be STOKED if you decided to do this!
Yeah I actually have been wanting to make some badge cards. It’s on my list of things to try and make time for soonish!
Hello, very thank you for the video. However, do you set the youtube autotranslate subtitle option into vietnam? Very confused how to change back to English autotranslate subtitle,.
Hmmm.... I don't usually set anything for the subtitles.... are you saying it was switching between the 2?
@@ICUAdvantage I found this video using vietnam subtitle, and I couldn't change it into English subtitle, very wierd.
@@黃紹閔 hmm I’ll try to look into it. Thanks for the heads up
🎯✔💯 Awesome review.😁
Thanks Jill!!
What os TPN, cvp ando the other abbreviations?
Thank you so much!!!!!!! 😁
You're welcome Kim!
Thank You so much
Lovely graphics!
Thank you!
@@ICUAdvantage OMG you replied. I'm starstruck. I'm an RN binge watching your videos for a placement exam to work in an acute setting after a long time being away from it. I sure am glad I came across your channel. You're a godsend! Please keep up the amazing work! 🙂
@@jhonrydc110 haha man just another fellow nurse out here. Nothing special. Just trying to help educate. Really glad you enjoy the videos and find them helpful. A LOT of videos these days to binge haha.
Thanks !
Why 3 CC syringe not used for rapid infusing Drugs ???please explained in details
It can cause too much pressure and can damage the lumen.
So I have a tunneled central line (Hickman) but I’m allergic to the skin prep so my question is since I can’t use the bio patch should I be doing a dressing change more often than every 7 days? And if so how often? I just use alcohol and stat lock and tagaderm and had remained infection free for 13 months. But could possibly doing a dressing change every 3 days be preferable? I read somewhere that was protocol if the bio patch isn’t present. But sadly my team though extremely caring aren’t the most knowledgeable especially on all of my conditions and the use of a central line so I need to educate myself. Thanks 😊 I’m on TPN by the way. 😉🥰
Thanks educated
Great glad to hear it!
Brilliant!!!
Thanks Karl!