Insertion technique for huge IV - the Rapid Infusion Catheter

[@MisterUnicornFL]

Where will you find 12 guys to hold me down while you do this?

[@liam_hurlburt]

eh, who needs men when you have 3 mg/kg of propofol?

[@d1zputed23]

He'll give you drugs

[@jewellry]

@@liam_hurlburt how would you give him the propofol with no iv?

[@Tigerprowltactical]

@@jewellry He’ll give you propofol through a smaller IV needle first. That will have less pain. This catheter is way too excessive for propofol and is used for a purpose that happens after you’re anesthetized.

[@user-tk2jy8xr8b]

One who requires rapid infusion usually can't resist

[@jimmclendon5404]

Ironically, this morning I looked at my dog and said let me show you something I learned on KZbin. I was unaware that he had been looking over my shoulder while I viewed the video with laser focus. For a critter without opposable fingers it baffles me he was able to not ONLY get out the door but escape in my SUV. On the serious note, you are the go to doctor for patient and clear presentation of the subject matter. I applaud you Sir.

[@Velmakinzy]

Not a medical specialist here: What circumstances would require the use of something like this?

[@MaxFeinsteinMD]

Hi Celine this type of catheter is used when large volume of blood loss is anticipated, as this facilitates rapid volume resuscitation. For example liver transplant surgery or big vascular surgery.

[@Rickytikkitavi]

I've had this happened where a patient was brought up to the ICU and we were taking care of a patient with massive arterial hemorrhage and we ended up doing massive transfusion of around 30+ units of PRBC alone where the surgeons were working on the patient too. He survived 😳

[@Rickytikkitavi]

@@sburt1998 the patient came from ED and upon arrival to the ICU and upon arrival we noticed his BP kept dropping and going up on BP supporting medications (central was done at ED) and physicians arrived quickly thank God the internal medicine team was near by with an ultrasound machine and they did detect hemorrhage

[@Rickytikkitavi]

@@sburt1998 it's not common to see bedside surgeries in the ICU if the patient is too unstable to bring to the OR

[@SoapsAreStupid]

@@sburt1998 A central cordis has a maximum rate of ~333mL/min when no side ports are being used. This has double that. And if you need this level of flow, you’re probably also infusing pressors- which you would be using the cordis side port with a DLIC- which slows down flow. This allows for an independent access point for large bore fluid rescusitation while the cordis/CVC can be used for pressors, CaCl, etc. Or you can put in two central introducers. But a RIC is faster in flow and quicker to insert.

[@melissasaint3283]

I can't tell you how glad I am that you will be called on to do this job and not me. Your voice is so calm and soothing!

[@franciscorojas5739]

Oh shit! I just learned central venous catheter insersion in my anesthesia elective. Thanks!

[@MaxFeinsteinMD]

Nice! RICs are technically peripheral catheters but central catheters are very important, too.

[@Spiritualpanda2]

I had my central line placed when I was under anesthesia. I had my entire spine fused(lacking neck fusion) was a 10 hour surgery. I’m so glad I was knocked out for that!

[@jotunmey]

I am so happy to be under when I had mine during my DIEP surgery.

[@ianshelton6662]

Would you numb it first? Is the patient sedated?

[@MaxFeinsteinMD]

RICs are usually placed when a patient is under general anesthesia, otherwise yes local anesthetic is given to numb the area.

[@ianshelton6662]

@@MaxFeinsteinMD RICs look like tunnels compared to the peripheral catheters used in dental surgery.

[@lynnefairchild7857]

I've had several central lines and can only wish I would have had some sort of anesthesia!! I had a bit of Lidocaine to numb the insertion site but a touch of sedation would have been appreciated. It was painful.😢

[@maebe1210]

Thank you max ! I always wondered how it's done because haven't seen one put in at work yet. Also Can't believe Australia has all the same brands you use in USA loll.

[@rhondafurr7000]

Can you explain or even do a quick video of why doctors work 24 hour shifts. It seams mistakes could happen due to limited sleep.

[@a.k.7116]

YES!!! INSANITY

[@bathedincloudsofblood]

the answer is mistakes do happen because of it and it's an insult to their talent and importance

[@seanathanbeanathan]

​@@bathedincloudsofblood This. Mistakes from overwork fatigue are preventable

[@mccluskey_xyz]

Passing a catheter over a guidewire is called the Seldinger technique, named after the Swedish radiologist who introduced it in 1953.

[@fishingfan1500]

Having had PICC lines, a Hickman's catheter and dozens of Canulas this still gives me shivers 😵

[@angryface01]

I had one of these kits in my sets when I was teaching but had no idea what it was! Thank you! I had never gotten around to looking it up before I stopped teaching!

[@Viscool8332]

Honestly, i'd rather just leave if i had to get one of these inserted without an anesthetic. it just LOOKS painful but still pretty cool

[@bitterlemonboy]

You are not allowed to leave.

[@arabellatirpak5436]

How does the heart beat under anesthesia?

[@flossenking]

The sinus node which generates the heart's rhythm is not part of the central nervous system and thus not affected by general anesthesia

[@kakefyll]

Do crnas also use these or just anesthesiologists? If there is a surgery with more anticipated complications would it be more normal for a doctor to provide anasthesia?

[@stevebot]

Thanks for showing me something I never want done to me.

[@garyjsimm]

Loved it. More shorts

[@MaxFeinsteinMD]

Thanks for the feedback! This was my first short so I wasn't sure if it felt like too much info crammed into a short video. More to come!

[@garyjsimm]

@@MaxFeinsteinMD nope. Concise and informative

[@BoogieDownProduction]

@@MaxFeinsteinMD Please more. Thank you

[@darriontunstall3708]

Great! Thanks ! I always was wondering how it was done

[@roche320]

My anesthesiologist used a paediatric needle when he inserted my IV before my surgeries. Watching this makes my arm lose sensation.

[@robertabray-enhus3198]

Under general anesthesia Good! Because I’m not going to be awake while you stick this in my arm What would this be used for? That’s a lot of medication fluid in a minute

[@ajessm]

Where would you find a vein big enough to hold so much fluid?

[@flossenking]

Femoral vein or basilic vein I'd assume

[@jarredbarber]

how do you keep air out?

[@jcbchannel8847]

Hi Dr, Thanks for the videos. I am having two wisdom teeth removed under general anesthesiology in the surgery center, can you do a video on what that will be like please? will it be like a regular operation? Just curious.

[@RoyalHam]

Usually what vessels are chosen for the insertion of RICs?

[@stewski695]

Almost always antecubital. It needs to be a robust, straight vein to handle a 7F RIC catheter, but also shallow enough for the regular PIV to be placed first

[@Saxatom]

Hello sir ! If you are unable to get large enough access for this, could you utilize an Ultrasound to find a bigger peripheral vein ? (Specifically for the RIC)

[@YTwatcherer]

What are ‚CCs‘ ? cm^3 = ml ? I really don’t understand what is you American’s problem with the metric system 😅

[@flossenking]

yeah, cc is for cubic centimeter

[@andrewlorentz685]

Isn't that a pic line or is it just a regular iv?

[@carolynuschock9028]

Fluid overload?

[@jusgeo89]

making it look easy

[@MaxFeinsteinMD]

Difficulty is really just a function of who’s watching

[@MrWavecap]

🖤you da the man

[@thebenandfridayshow]

Good job anesthesia

[@kyles1399]

I've had this done it so painful now I've got a Portacath in my chest now instead

[@nickgavis0305]

At first I was like they never made an incision when they put in my catheter. But then i saw it said huge catheter

[@paulpoppenfuse7071]

Thanks

[@PrairieB]

Would this be possible in a patient with v small veins effected by EDS?

[@kitkatd1]

I’ve got EDS my veins are horrendous. Have a Hickman line for access for meds, fluids etc and taking blood. I’ve had 3 IOs put in this year 😕

[@dr_abinss_021]

Great keep going on

[@aliennetwork08]

I remember waking up intubated and having a catheter really sucked I was 21

[@emeye6452]

Have u ever forgotten a step and realized at the last second

[@eliahsmith9512]

Is this the same thing as a central line?

[@ustabee6091]

@Dwayne The Coke Johnson A central line is any cannula or catheter tip positioned in a central vessel (vein or artery) like subclavian, vena cava, aorta or any of the pulmonary or cardiac vessels.

[@flossenking]

No, a rapid infusion catheter is usually placed in a peripheral vein like the femoral vein or the basilic vein. A central venous catheter (central line) is placed in a vein more close to the heart, like the veins mentioned in the comment above

[@sunny71169]

Looks like that system would work better in the field than trying to place a 16 or 18 ga. angiocath in an unconscious hypovolemic trauma patient. Your thoughts?

[@liam_hurlburt]

1. Max starts by inserting a 18ga, so if that was all that was needed he could just stop there 2. Have you ever tried to maintain a sterile field while outside the hospital? Yeah, it's a pain, and if I don't have to I'm definitely not going to

[@davidadams9391]

When I’m getting a catheter I don’t want to see a scalpel!! Interesting video….Thanks Dr Max. Happy Thanksgiving!

[@MaxFeinsteinMD]

Rapid infusion catheters are generally inserted while a patient is under general anesthesia - I don't blame you for not wanting to see a scalpel! Happy thanksgiving to you too, David!

[@lachyt5247]

Every procedure we do (interventional cardiology) involves insertion of usually a 6fr arterial catheter into the radial or femoral artery. They're almost all done under very mild conscious sedation with local anaesthetic. They really aren't that bad.

[@barbtowner8086]

That sounds horribly painful

[@lissyniña]

wow lot of fluid.

[@salventuri2050]

Sometimes my Huge IV doesn't fit.

[@huh387]

well i just hope u give anesthesia first cos that looks like its PAINFUL

[@quanto4297]

Please please please tell me you would never do this to a patient who’s awake

[@a.k.7116]

OH.

[@Clarkson350]

Hope your out

[@sarahpomerantz2201]

OWWWWWWWWW

[@sveiniscute9101]

Lolks scary