Ultrasound Guided Vascular Access

[@domagojmusulin9200]

I think this is the most complete video about USG VA on internet! Greetings from Croatia 🇭🇷

[@andreastewart4215]

I have been doing this for at least five years maybe a little longer. I’ve always given myself an 85% success rate. Your video helped to validate what I was doing correctly and showed me opportunities for improvement. Thank you because I’m pretty sure when I first started doing this there weren’t that many ultrasound videos and the ones I did find were not great. The past few years there have been some that have been better but yours by far has been the best. I look forward to going to work and the next time someone wants me to try to start an IV using the ultrasound I will be trying these techniques. Thank you so much for sharing.

[@MetroHealthEmergencyUltrasound]

Thank you for the kind words

[@jennysong6078]

TY for this informative lecture! I've been struggling with ultrasound guided vascular access for difficult patients but I'm looking forward to trying it again post watching your video !

[@bettysmith4527]

The key is slow and steady wins the race!! I think we get so used to going fast when we do "blind sticks" we don't slow down when we first start doing us guidance. Slow is key!

[@MetroHealthEmergencyUltrasound]

Agreed

[@MetroHealthEmergencyUltrasound]

Your welcome! I've found that being very deliberate is the key to being successful. Let the probe guide the way for the needle. It's counterintuitive until you get used to the technique. Best of luck!

[@yuehhanlin]

Thanks that was very comprehensive. Any suggestions about applying traction for loose skin. Sometimes i run into issues puncturing the vein on older patients.

[@MetroHealthEmergencyUltrasound]

Thank you. Loose skin is less important with ultrasound. Once you get under the skin, follow the ultrasound to guide the needle to the vein. Rolling veins can be a problem. When you get the needle tip over the vein where you can see some tenting of the vein wall, give the needle a sharp pop and you can usually get the needle tip in the vein.

[@berserksc2]

How can you tell if there are nerve bundles around the vein?

[@fredjones554]

Learn the anatomy of the large nerves, especially when they are superficial. If you are gentle and you hit one anyway, the patient will tell you (electric shock pain), stop the procedure immediately and pull out. Just touching the nerve will cause pain before you have injured it. Pull out immediately. Most nerves are pretty strong and recover well if you are gentle. Even if you are not gentle, most nerves recover well but it may take 6 months. This is from spinal anesthesia data.

[@bettysmith4527]

Meh, those probe covers are around 7.00 a piece. I work on a vascular access team and we still use Tegaderms for regular PIVs without any issues. We wipe the outside of the teg with CHG once it's on the ultrasound probe and use sterile gel, and obviously clean the arm with CHG.

[@MetroHealthEmergencyUltrasound]

Yes, they are not cheap. We do not recommend tegaderms because they are not approved by the manufacturers to be used on the probe heads and they are not FDA approved as a microbial barrier. That being said, there is some interesting literature in this space that is far from definitive on the topic.

[@shamjayas8525]

Too long