Central Line Catheters

[@Sisyphussa01]

Best video ever made. Nobody ever demonstrates where the distal, medial, and proximal lumens open and there are no reliable sources of this. I've been at it for an hour and your video was the first one I came across that contained such information.

[@PainH8er]

THANK YOU!

[@vkuslekar]

Very simply explained the aspects in brief. Thank you sir.

[@eurah3]

Very helpful and informative. You make complicated things a lot easier to understand. Thanks a lot!

[@propofolau]

No problems - I think it was just an oversight, but it's nice to acknowledge that everyone has responsibility and accountability to know the correct ways to use their equipment safely and effectively. Thank you for considering my comments and your desire to make edits to your video. I appreciate that.

[@ajtrevor02]

Sir thank you very much for very informative videos. It really helps me a lot specially in my profession as an anesthesia assistant where we rarely experience CVP insertion. I dont have the skills to assist the anesthetist thats why I rely more on educational materials. Sir, can I request for video on preparing on how to avoid bubbles inside the CVP tubing and priming of CVP line. ...thank you very much

[@sayedjubran8954]

Excellent iformative valuable tutorial.Thank you.

[@PainH8er]

I'm not quite sure that I followed all of your comments, but thank you for your interest!

[@PainH8er]

Great, and thanks for the compliment.

[@propofolau]

Thanks for your reply. My comments were generally focusing on the safety aspect, but also the educational considerations when making youtube videos that novices may also be viewing... I guess we need to be acutely aware that "I watched/learned it on KZbin" is not a satisfactory or empirically-validated platform for good adult learning, and often highlights extremely variable clinical practices (both good, bad, and everywhere in between). In answer to your replies; 1) My apologies to you on the PSI statement; you are correct (I missed you saying it) - however, you still call it a 'Cordis', which it is not. The term Cordis refers to another brand of product that is not shown in this video. This is a common misrepresentation due to the various brands and configurations available, and so everything is often referred to as 'the same thing'. This frequently happens also with clinicians referring to a subclavian catheter, when it's clearly inserted in the axillary vein (infraclavicular fossa) - but that's a story for another time! 2) It looks as though you may have activated the locking mechanism when adding the SLIC, however, it is unclear and quite difficult to see on the video - and it's not mentioned in the voiceover, which is more really my point. The use of a regular central venous catheter (without the companion device locking hub) is, unfortunately, a commonplace wrongdoing, and it is not without risk. e.g: think of the repositioning/movement of an ICU, inotropic-dependent patient who has their CVC accidentally removed because it has not been correctly locked and secured properly. The loss of vascular access could be catastrophic. The risks are very real. #3) While it's difficult to determine every clinical scenario around accidental catheter removal from the PSI, there is ALWAYS a potential risk to the patient. One thing I will say about the hemostatic valve is that if a device has been removed from the PSI, then an occlusive needle-free device/end cap should be attached to prevent any unwarranted risks of positive or negative movement through the valve. It's all about safety and prevention of complications in this case. Thank you for the dialogue - it is important that all clinicians viewing this video, regardless of their levels of experience, want to learn and ensure appropriate patient safety considerations in all aspects of central venous catheterization and are aware of the correct use of the devices they chose to insert into their patients. There is a responsibility of everyone to be familiar with their kit and how it works.

[@PainH8er]

Hey this is another great comment. I agree with your points. I tried to get on the video editor and add some text to explain the locking mechanism, but it won't allow me to! I guess KZbin won't allow post-upload text boxes anymore :(. It will, though, allow me to trim the video, and I did trim the section that showed the double lumen central line catheter posing as a companion catheter once it was advanced all the way. I'm hoping that that will avoid some confusion. If there ever is a way for me to add text to explain the importance of the locking mechanism I will make sure I do that. Thanks again :)

[@tommac21]

Give me the smallest one please !

[@TheMrriyadh07]

Very helpful, thank you bro

[@shinepreet7846]

Very helpful ... thank you

[@propofolau]

I just came across this video of yours. Now somewhat older, I would like to address some issues that is still relevant in today's clinical settings. Please ensure you are teaching the correct way to use the "companion" pieces with the PSI - it is not a "Cordis" - that is a brand name only. The correct name of this device is a Percutaneous Sheath Introducer (PSI). The SLIC locking mechanism was not addressed or how to activate it in your video - this is a key safety issue for ALL clinicians using these devices and everyone needs to be precisely educated on the appropriate and correct way to use these devices together. The companion pieces (SLIC and other multi-lumen configurations) all have the locking mechanism to prevent air entry into the system through the hemostatic valve, and to prevent unwanted accidental removal of the companion devices. Patient safety is paramount always - so please ensure that you understand how these devices work together and how to use them correctly before educating others - the lack of attention to safety in this video opens a serious number of clinical concerns and it should be noted by clinicians who are turning to KZbin for education. Please always check with the manufacturer or the instructions for use of the device before using unfamiliar equipment or to ensure you have the correct components/companion devices.

[@PainH8er]

Great thoughts. I'm going to leave this up here so people can see it. Allow me to make just a couple of comments: 1. I do in fact refer to the Cordis as a Percutaneous Sheath Introducer (PSI), so I'm not really sure why you mentioned this. 2. I do hook up the locking mechanism on the SLIC catheter, so I'm not sure why you mentioned this either. 3. You got me on the "companion catheter." I didn't have a real companion catheter with the locking mechanism in the lab. I was trying to work with what I had available, I used a double lumen central line catheter as the companion catheter to simply show that it's possible to add extra ports when using a PSI. This is great feedback and I will edit the video to explain :) Now help me out here. Let's say that I didn't use the locking mechanism, which led to the SLIC or companion catheter coming out. What safety concern exists, other than the fact that the patient would no longer be able to receive the benefits of the catheter that was removed? The patient would not bleed out because the introducer port has a one way valve in it. Agree? Thanks for the comment!