Thank you so much for your kind words about our material! We're huge fans of your videos. I especially like your emphasis on counter-traction on dilation and we will be sure to refer to this in our upcoming videos. Feel free to check out our central-line academy where we go into our takes on the all things CVC. kzitem.info/door/PLXMXmK2usNlOQC2nMKQd_UkB5hfQxw_HG
@tedhon911
Ай бұрын
Thank you, professor. You are the go-to source for thoughtful, practical ultrasound instruction for students of anesthesia - new residents and old timers alike.
@streen2000
3 ай бұрын
You're on a weekend roll prof. This is awesome
@asherkaz
3 ай бұрын
What an amazing video and instructions! And the graphics were absolutely indispensable.
@kelvinlo2243
2 ай бұрын
Hi Dr Chin, thank you for your great content. I am an anaesthetic reg in australia. In my experience, the subclavian is relatively uncommon, this video inspired me to convince one of my consultant to supervise me, which was successful and satisfying. Your videos help me think critically about each small step. One question I had was that I noticed a vascular bundle of small veins and arteries right above the sub clavian vein just distal to where it dives under the clavicle. What is your approach to that ?
@KiJinnChin
2 ай бұрын
Congratulations on stepping outside your comfort zone to learn this useful technique. Without a picture, I cannot be sure I'm answering your question accurately. Nevertheless, (a) we often see the cephalic vein taking off from the subclavian just distal to the clavicle. (you see it just off to the right of the screen from 2:52-3:05) (b) if imaging more distally, there is often a bundle of vessels between pec major and pec minor (see 2:40 in the infraclavicular video kzitem.info/news/bejne/wI2nsKR3gpV0mqg). Regardless, my approach to avoiding vessels in the trajectory is the same: approach them at a tangent to their surface, advance slowly and gently, and they will usually slide aside as the needle tip nudges past. As you may know from peripheral IVs, veins that aren't fixed in place are suprisingly hard to pierce!
@LucaOrsini-s2d
3 ай бұрын
Great video. Thank you so much for the amazing teaching! Do you think, for this particular case (obese patient, large catheter), it could be easier to use a landmark technique, in particular for the insertion part of the procedure? Maybe a more horizontal trajectory ( that I think is common in the landmark technique compared to the echo) of the needle and, therefore, of the wire could facilitate the catheter insertion? Thank you so much again!
@KiJinnChin
3 ай бұрын
Good question .. I think the landmark technique would probably land you closer to the clavicle and vein, so a shorter passage through less soft tissue, and thus potentially somewhat easier. And, as you say possibly more horizontal trajectory - IF you use the technique described in my other video, vs a "walk-down" approach that can result in a steeper dive to get under the clavicle. Nevertheless, I think it's still useful to appreciate that care must be taken to ensure that dilator/wire is not bending, and how to handle any challenges that may arise from trying to drive the catheter through the tissues. I have found it to be something that happens fairly often.
@LucaOrsini-s2d
3 ай бұрын
@@KiJinnChin Thank you so much for the answer. Great advice!
@Chocoecstasy
3 ай бұрын
Thank you for the wonderful demonstration. I have a learnt a lot from various videos you have shared. It would be nice if can make further videos on ultrasounf guided sarcoiliac joint and caudal injection. Best regards,
Пікірлер: 11