As an RRT, we are competent with arterial puncture without ultrasound. Can you comment on NOT using ultrasound for A-line placement? Also the pracitical use of lidocaine with awake patients.
I'm biased because I use ultrasound for virtually everything in my practice ranging from thora/paracenteses to vascular cannulation and peripheral nerve blocks. I don't think twice about it. In awake patients, I infiltrate 1% lidocaine superficial to the vessel (again, with ultrasound) before I prepare anything else to give the local anesthetic some time to work. During my days as a resident, I worked at hospitals where ultrasound was not as widely available and did most of my lines by palpation and the "through-and-through" method. I just think using an ultrasound is safer and, often times, more comfortable for patients who are "difficult sticks" and we would be "fishing" for the artery with a needle.
I was a CRT back in the 1970s and had to do a lot of ABGs in various hospitals. When I got a job at a heart and lung center in NJ, I started the 11-7 shift and was the only tech during that time. The RT Dep't head went with me on an ABG stick to observe and confirm my background. What surprised me was they used heparinized glass syringes. I thought it was ancient using them instead of the standard plastic syringes. So, I had to add some heparin and work the plunger a few times and then go into the radial artery. And yeah, the pulse was very evident as the syringe would advance up with each pulse. I was then sold on that technique. Now I'm 75, had a triple bypass surgery last month and watched the cardiac cath done prior to the surgery. The surgeon asked if I had any questions and I told him "no, I've watched a load of RUclips videos on this procedure". The he and the nurses laughed out load. He said maybe I could do my own cath. I replied "pass the syringe and cannula to me. Unfortunately my 3 primary coronary arteries were all blocked 95+%, so no stents. Cheers, Bob (good vids, Dr. Kumar!)
Dr. Kumar, I love your posts! Thank you so much for sharing the knowledge. Reference insertion of radial arterial lines, I’m right-handed and as a flight Nurse, I sit on the patient’s left side in the aircraft. Thus far, I’ve been successful at placement of art lines in flight, but are there any recommendations you could provide for continued success using the non-dominant hand? Thank you.
Thank you for everything that you do as a flight nurse! Honestly my best recommendation is practice! I've gotten in the habit of trying to use both hands (and awkward positions) to place lines these days just in case there's a time (ie, trauma, in the field, etc.) where the experience will come in handy.
Dear Rishi...I always recommend your Instagram posts to our residents in the university hospital where I work.This video should have been more detailed.I was expecting a real life application of an arterial line with or without ultrasound use.The various technics would have been discussed.The video is nevertheless informative.But as I said earlier it was done by you and it is normal that my expectations were a bit higher than usual. Best wishes from the University of Marmara Pendik Training and Research Hospital, İstanbul, Turkey.
Great Post Dr. Kumar. I have a little trouble following the minute steps of the cerebral DSA procedure. I mean e.g when to inject puff contrast to ensure your cath position or when to inject some saline-diluted heparin and so on! I am looking for a video showing these minor steps in a slow manner with explaining the logic behind each maneuver. Can you refer me to any resource? Thanks in advance Dr. Kumar
"Walking" the line in via ultrasound is a good idea only to get the first 1cm well seated in the artery. The expectation of visualizing the catheter all the way in via ultrasound actually increases risk of needle penetrating outside of vessel. Remember sterile gloves, sterile probe cover and sterile gel.
As an RRT, we are competent with arterial puncture without ultrasound. Can you comment on NOT using ultrasound for A-line placement? Also the pracitical use of lidocaine with awake patients.
I'm biased because I use ultrasound for virtually everything in my practice ranging from thora/paracenteses to vascular cannulation and peripheral nerve blocks. I don't think twice about it. In awake patients, I infiltrate 1% lidocaine superficial to the vessel (again, with ultrasound) before I prepare anything else to give the local anesthetic some time to work. During my days as a resident, I worked at hospitals where ultrasound was not as widely available and did most of my lines by palpation and the "through-and-through" method. I just think using an ultrasound is safer and, often times, more comfortable for patients who are "difficult sticks" and we would be "fishing" for the artery with a needle.
I was a CRT back in the 1970s and had to do a lot of ABGs in various hospitals. When I got a job at a heart and lung center in NJ, I started the 11-7 shift and was the only tech during that time. The RT Dep't head went with me on an ABG stick to observe and confirm my background. What surprised me was they used heparinized glass syringes. I thought it was ancient using them instead of the standard plastic syringes. So, I had to add some heparin and work the plunger a few times and then go into the radial artery. And yeah, the pulse was very evident as the syringe would advance up with each pulse. I was then sold on that technique. Now I'm 75, had a triple bypass surgery last month and watched the cardiac cath done prior to the surgery. The surgeon asked if I had any questions and I told him "no, I've watched a load of RUclips videos on this procedure". The he and the nurses laughed out load. He said maybe I could do my own cath. I replied "pass the syringe and cannula to me. Unfortunately my 3 primary coronary arteries were all blocked 95+%, so no stents. Cheers, Bob (good vids, Dr. Kumar!)
Dr. Kumar, I love your posts! Thank you so much for sharing the knowledge. Reference insertion of radial arterial lines, I’m right-handed and as a flight Nurse, I sit on the patient’s left side in the aircraft. Thus far, I’ve been successful at placement of art lines in flight, but are there any recommendations you could provide for continued success using the non-dominant hand? Thank you.
Thank you for everything that you do as a flight nurse! Honestly my best recommendation is practice! I've gotten in the habit of trying to use both hands (and awkward positions) to place lines these days just in case there's a time (ie, trauma, in the field, etc.) where the experience will come in handy.
Dear Rishi...I always recommend your Instagram posts to our residents in the university hospital where I work.This video should have been more detailed.I was expecting a real life application of an arterial line with or without ultrasound use.The various technics would have been discussed.The video is nevertheless informative.But as I said earlier it was done by you and it is normal that my expectations were a bit higher than usual. Best wishes from the University of Marmara Pendik Training and Research Hospital, İstanbul, Turkey.
Really appreciate the feedback! I might do a "real life" example (with patient consent) in the future!
🙂 Thank you !
Great Post Dr. Kumar.
I have a little trouble following the minute steps of the cerebral DSA procedure. I mean e.g when to inject puff contrast to ensure your cath position or when to inject some saline-diluted heparin and so on! I am looking for a video showing these minor steps in a slow manner with explaining the logic behind each maneuver. Can you refer me to any resource? Thanks in advance Dr. Kumar
I know what you need! A volunteer!
Hahaha, maybe in version 2.0 of this video!
I just had this procedure done, but why is my wrist and forearm hurting so much 3 days after?
Great post. Love the top down shot.
Good sir thank you
Delta hospital akhane cardiace c c u i c u khulese arterial line canula need aktu help koren
"Walking" the line in via ultrasound is a good idea only to get the first 1cm well seated in the artery. The expectation of visualizing the catheter all the way in via ultrasound actually increases risk of needle penetrating outside of vessel. Remember sterile gloves, sterile probe cover and sterile gel.
Real time please with ultrasound
I really don't like this artery being so close to the skin.