TheVascularGuy

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@jeremyrocha2974 14 сағат бұрын

Bro! Come to Dallas. I could get a bunch of people to show up

@thevascularguy 2 сағат бұрын

@@jeremyrocha2974 hellyea, if youre serious, email me at [email protected]. Lets coordinate

@americangirl4288 3 күн бұрын

I can't believe someone asked that about a picc. That is scary that people caring for piccs or those with them don't realize how dangerous that is. No wonder doctors are very hesitant to have them placed.

@thevascularguy 3 күн бұрын

@@americangirl4288 yup! And it comes from lack of knowledge from the clinicians who discharge them. Patient education is definitely low on the priority.

@ariahsu2915 8 күн бұрын

Will you one day show us to tunneling PICC in upper arm targeting axilla vein? I live in Maryland and is a PICC nurse (but just regular PICC nurse not the advanced one like you). I always wish I could shadow you one day, the video makes this possible! 😊

@thevascularguy 7 күн бұрын

@@ariahsu2915 got one in the works!😎🤙

@nealpickering7265 8 күн бұрын

I'm assuming RIJV and the subclavians/femorals were not available?

@thevascularguy 8 күн бұрын

@@nealpickering7265 close! LIJV the subclavians are contraindicated for patients with projections for dialysis to protect the flow path for dialysis. Unfortunately, previous traumas will sclerose the veins. Inguinal fem and mid thigh fem was too high risk for infection compared to tunneled IJ.

@nealpickering7265 8 күн бұрын

@@thevascularguyinteresting rationale. I place apheresis/dialysis lines as well as TIVADs and hickmans etc. I would have thought a femoral hickman with it tunneled to mid thigh and the dacron cuff would minimise infection risk? The insertion looked faffy and the lateral approach likely resulted in the line doubling back on itself. Is there anything you would have done differently if you were to approach it again? Also with regards to the ST elevation I don't think you should feel any guilt there. Intracav ECG confirmation is just that amd your focus lay in the procedure. With no other signs or symptoms to suggest an ECG was required it was more of an incidental finding that may have already been pre-existing. Did you see any of her other ECGs?

@a22fc 9 күн бұрын

Are you an RN brother? I wish we had programs to learn this for RN’s

@thevascularguy 8 күн бұрын

Yes I am an RN. It's a very small group of us that are trained for these. It really depends on the state's allowing you to do it and clinicians like me willing to pass down the knowledge. This should be a specialized nurse procedure. These devices are nurse tools not provider tools.

@a22fc 7 күн бұрын

@ that is so cool! Wish we had that kind of support 👍🏼

@mlontra 9 күн бұрын

Kudos for spending extra time to make the procedure less painful for what seems to be a very frail patient. Almost ASMR-esque!

@thevascularguy 8 күн бұрын

No groaning from the patient is definitely ASMR! LOL

@eugenejkim 9 күн бұрын

Awesome needling. Love it. Couple questions though 1. I didn't see how you fixed the double back, how'd you straighten that guy out? It looked like several cm double backed but hard to tell. Only saw the secure cath being placed after seeing the double back 2. would having more guidewire in prior to placing the PICC catheter reduced the odds of it doubling back?

@thevascularguy 8 күн бұрын

Great questions! 1. The only thing I did was sit the patient straight up and gravity pull the tip down towards the cavo-atrial junction. I got very lucky! 2. With traditional seldinger (over the wire) cannulation yes but not with this MST (Modified Seldinger Technique) because I needed to remove the wire to insert the catheter into the dilator sheath.

@smercer1992 9 күн бұрын

This is the videos I'm here for. 🎉🎉

@thevascularguy 4 күн бұрын

😁🙏🙏🙏🙏

@HuiSauce 9 күн бұрын

Significant adipose in the green & yellow zone limiting visualization of vessel. Cephalics tend to be a great option for the bariatric patients but they do not always have adequate sized cephalics even though they tend to have the best ones. Basilics and Brachials can sometimes time be >5cm in depth. Not impossible, but sometimes, visualization, insertion angle, and the tools available do not create an environment for success. The only times I place distally is for the same reasons you mentioned in addition to bariatric populations with an extreme amount of adipose tissue.

@thevascularguy 9 күн бұрын

100% that loooooong needle comes in handy!

@americangirl4288 11 күн бұрын

Im so glad i found you here on KZbin. I left TT a fewcmonths ago and am happy i'm starting to see those i followed pop up here. Thanks for all you do.

@thevascularguy 11 күн бұрын

@@americangirl4288 glad you found me here! So encouraging to hear these videos are helpful😁🙏

@MrWakka123 12 күн бұрын

Diffusion instead of osmosis brother. Osmosis refers to movement of water via a partially permeable membrane

@thevascularguy 12 күн бұрын

That’s the word I was looking for!🙏

@TheEarthHistorysConfusing 12 күн бұрын

Context please!.

@pablohenrique3559 14 күн бұрын

Can't wait to see more!

@mace_x6277 16 күн бұрын

hey man im not a laser expert but maybe you shouldnt be pointing them at mirrors without wearing any eye protection

@mahmudpritam2370 17 күн бұрын

No sound at 1st 10 minutes

@X1OAFREED0M 17 күн бұрын

Appreciate your content.

@thevascularguy 15 күн бұрын

@@X1OAFREED0M 😁🙏🙌

@jeremyrocha2974 18 күн бұрын

Great illustration Dennis! If you had some BD Nexivas, I had an idea for another illustration you could show. I’ve found that when detaching a syringe, it can create enough negative pressure to pull blood into the catheter. So a nurse will give a med and flush the line thinking the line is now clear of blood but if they don’t clamp before detaching the syringe, blood will enter the catheter and will be clotted before their next use. We are always having to replace these catheters due to occlusion. I’ve been on a rampage at my shop trying to teach the nurses to clamp while flushing… then detach the syringe. Anyway, I met you at AVA in Colorado. Talked for awhile. You’re doing the Lords work dude. Keep it up!

@thevascularguy 15 күн бұрын

@@jeremyrocha2974 that’s a great idea! Off to play around with 1 when I get a hold of it!

@christopherpresley7608 18 күн бұрын

So you would pull the catheter out and re cut if you had 3cg? I have a co-worker who says this should not be done.

@thevascularguy 15 күн бұрын

@@christopherpresley7608 depends on the insertion if it was difficult to advance the catheter I would risk getting stuck during the reinsertion. But if the external length was excessive and there’s no indication of difficult advancement I would trim for sure. Anything above 3 cm exponentially increases the risk of dislodgment. And catheter dislodgment is absolutely the number one priority to prevent from happening.

@christopherpresley7608 14 күн бұрын

@thevascularguy, thanks for the response. I couldn't agree more. My co worker thinks it increases the risk of infection by exposing the catheter to the air. I never really understood the argument.

@Thomas-gk8mt 20 күн бұрын

I used to do the same thing but it really doesn't do anything to be honest with you

@salomonmontalvojr.7958 24 күн бұрын

Sick, Informatics is the way 🤌🏽 #informationtechnology however, one of the serious problems w/in our nursing/medical culture is worsened by patchwork IT that inevitably causes issues w/communicating w/other patchwork/main software - I understand HIPPA is a main source of HA for IT tho…it seems to be a catch 22 w/in our industry - innovative findings suppressed by lack of effective software communication to engage the most effective personnel/AIML to interpret that info effectively 24/7, so I guess I just want to ask where have u seen this this implemented and how has it been going? Super exciting software tho!

@salomonmontalvojr.7958 24 күн бұрын

You mean to tell me ICU didn’t complain about it not being a TL PICC bro?! Teach me ur Jedi mind trick ways brother 👊🏽😂

@thevascularguy 24 күн бұрын

@@salomonmontalvojr.7958 🤣😂🤣

@bentaylor7603 25 күн бұрын

First, I wanna say your content has been a blessing. I was recently trained on Ultrasound guided access and watching your videos greatly contributed to my success and knowledge. Secondly, I think it’s a both/and. VAS teams are a great resource but nurses need to be educated and trained more thoroughly on IV’s, cath/vein ratios, DIVA’s, technique and so on, that way we aren’t causing unnecessary harm to pt’s, and we aren’t relying so heavily on those services (especially on night shift where we don’t have a team present at my facility).

@thevascularguy 25 күн бұрын

@@bentaylor7603 so encouraging to hear! Thanks for the update🙏🙏🙏😁

@bula9737 26 күн бұрын

Nice, bro. Thank you, that was informative for the layman like myself.

@thevascularguy 25 күн бұрын

Thank you! I’m glad it helps😁🙏

@texasdad2372 29 күн бұрын

Yep. I have only 1 vein that ANYONE has been able to draw from,in the bend of my right arm. Nurses have tried everywhere else and couldn't get shit,even had 1 nurse blow out a vein in my left arm for refusing to listen. After that,if they won't listen and do my right arm I get up and walk out.

@thevascularguy 29 күн бұрын

@@texasdad2372 gotta protect yourself from bad actors👏👏👏

@texasdad2372 29 күн бұрын

@@thevascularguy Yea I'm an ass when it comes to stupid drs and nurses. I don't care at all to call them out and make them look bad.

@RedRuneblade_Alt Ай бұрын

Thank you

@thevascularguy Ай бұрын

@@RedRuneblade_Alt I hope it helps!😁

@RedRuneblade_Alt Ай бұрын

@thevascularguy it's nice to see this side of things after seeing how dismissive certain medical professionals can be.

@Gunmetal_papi Ай бұрын

Had to do this for my dad when i was caretaking for him when he had ALS. RIP pops.

@FailSpace2 Ай бұрын

If I had a penny for every time someone tried to prove “ground-breaking” medical advice using only a personal anecdote, I’d be the richest person on Earth.

@oikelly Ай бұрын

😂 So sorry!!!!

@thevascularguy Ай бұрын

@@oikelly 🤣😭😭😭🤑🙅‍♂️

@evotryagain Ай бұрын

bro rippppp 🙏😭💀

@thevascularguy Ай бұрын

@@evotryagain 🤣💀💀💀☠️

@MOBILEVITAL Ай бұрын

Great video as always! Have you tried the iQ3 for PICC/midlines? I’d love to hear your thoughts on that.

@thevascularguy Ай бұрын

@@MOBILEVITAL Yes! I just got a hold of one. The “Out of plane” function is a game changer and I’m hoping they’ll do a 3D scan function for vessels soon. The image is slightly better than the IQ+. Bi-plane view has more FPS so it’s more usable but quality of image is still compromised with biplane. Echocardiogram for tip confirmation is a plus

@Darklightflash-z8j Ай бұрын

Oh Hell No!!!!

@thevascularguy Ай бұрын

@@Darklightflash-z8j 😂🤣

@AnubisPlayZ_GF-i6h Ай бұрын

Technology dosent benefit mankind at all

@AxelHunter-m5c Ай бұрын

Learn how to spell and I will listen

@Sskelll Ай бұрын

Starting a fight doesnt mean you have to be right 😂

@niketjadhav6896 Ай бұрын

I am a sales rep selling interventional radiology product can you create a whole course, Where you tell me parts of fluroscopy and usg

@allansarmiento4908 Ай бұрын

Push the fluid and clot further in

@ТимурКушнарев-щ3в 2 ай бұрын

Why are you used this type of punction? Is it better then traditional subclavia vena punction or jugularis veena punction?

@thevascularguy Ай бұрын

That's a great question! It depends on the treatment plan. It's easier to discontinue compared to a tunneled CVC but not always better. The length of therapy and quality of life with each specific device also needs to be considered

@klorofill9313 2 ай бұрын

Would you ask for heparin flush order in these cases? Sometimes I get ppl in ED for more than 24 hrs and their lines get a bit hard to get lab redraws from. I really appreciate your videos😊btw.

@thevascularguy 2 ай бұрын

@@klorofill9313 unfortunately Hepburn flushes won’t do much for these situations. If they’re going bad before the 24 hour mark, then most likely the thrombus is due to endothelial injury from standard suboptimal insertions.

@klorofill9313 2 ай бұрын

Damn this is really nice. Why do I feel it would take 5+ yrs to get it.😢

@thevascularguy 2 ай бұрын

@@klorofill9313 I know, right😔

@eugenejkim 2 ай бұрын

How do you like the Clarius linear US probe?

@thevascularguy 2 ай бұрын

@@eugenejkim the image is amazing! But the overheating makes it unusable during CVC insertions and long PIV recordings. As long as you’re inserting fairly quickly, it’s a great image.

@nachamu99 2 ай бұрын

So it’s not ideal, but ok to place an IV on an edematous arm if needed?

@thevascularguy 2 ай бұрын

Def not ideal but possibly appropriate. Risk to benefit analysis must be considered for every patient in every scenario. Swelling is not always a definite NO nor is it a yes.

@heybinggo 2 ай бұрын

Thank you for sharing, what ultrasound machine are you using?

@thevascularguy 2 ай бұрын

I'm using the Butterfly iQ3

@ChaseWatkins. 3 ай бұрын

Going to research and advocate for these (if they work) in my ED.

@thevascularguy 2 ай бұрын

@@ChaseWatkins. would love to know how it goes!

@alexe4743 3 ай бұрын

Excellent presentation!

@thevascularguy 3 ай бұрын

Thank you!😁🙏🙏🙏

@RoyalHam 3 ай бұрын

Can you please explain or show us what you were doing with the needle inside the PICC and with the black ECG electrode at 11:30?

@thevascularguy 3 ай бұрын

@@RoyalHam yes! Just need to finish editing

@NinjaSheepa 3 ай бұрын

Very nice! How far do you usually threat the needle once you are in the vein before ? Lost a stick yesterday after good visualisation of the needle in the vein and about 1.5cm of threading but then no blood after pushing in the catheter or later when withdrawing the catheter slowly, now I'm questioning my technique :/

@thevascularguy 3 ай бұрын

@@NinjaSheepa I threaten my needles all the time. Gotta make sure I keep them in line😂

@thevascularguy 3 ай бұрын

@@NinjaSheepa I try to thread the entire needle and catheter before retracting the needle when possible😁

@NinjaSheepa 3 ай бұрын

@@thevascularguy Thanks!

@chriscrocker9982 3 ай бұрын

Awesome video!

@thevascularguy 3 ай бұрын

@@chriscrocker9982 thank you!😁🙏

@tazibat 3 ай бұрын

You are "Edison" for phlebotomists :) while I know at least 13 specific causes, while this collection method is not working, especially for 22 ga, 1" PIV, being in place for couple days - you are just found one 1 1/2", which works! :) Ok. my "13": (starting with there is no Ultrasound Machine for assessing veins on the floor): 2. Fibrin Sheath Formation: Acts as a one-way valve, obstructing blood withdrawal. 3. Thrombus Formation: Clots within or around the catheter block blood flow. 4. Mechanical Issues: Kinking, compression, or malposition of the catheter impedes flow. 5. Vein Inflammation (Phlebitis): Swelling reduces vein diameter, hindering blood return. 6. Biofilm Formation: Bacterial accumulation increases resistance within the catheter. 7. Medication Precipitation: Incompatible drugs form blockages inside the catheter. 8. Residual Deposits: Inadequate flushing leaves clots or residues that obstruct flow. 9. External Compression: Edema or patient positioning compresses the catheter or vein. 10. Catheter Degradation: Material breakdown leads to internal obstructions. 11. Valve Malfunction: Anti-reflux valves prevent blood aspiration if faulty. 12. Vein Thrombosis: Clots within the vein itself block blood flow. 13. Vasospasm: Vein constriction reduces or stops blood flow temporarily.

@thevascularguy 3 ай бұрын

@@tazibat 😁🙏🤓💪