US-Guided Central Line: 10 Steps - Crash course with Dr. Hadzic 

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Thank you! We are happy that you find these videos helpful!

Thank you! Can you tell us more about where you practice and what NYSORA videos are the most useful to you? Best regards

Hi Ali Akram! Glad to hear this! Thanks!

Thank you for watching! Glad you like it.

Glad you liked it and thanks for watching!

Glad it was helpful!

Hi Ashish Ghimire! Thank you for your comment! Stay Connected! A lot more is coming soon! Greetings!

You are welcome!

Hi Thiago, So kind of you, and we are really glad you are enjoying our work. Greetings!

Thanks for the comment, we will take that into account when shooting the following videos. Until then, you can check the content we have on this topic on NextLevel NYSORA platform: nextlevelcme.com/pediatric-atlas-of-ultrasound-and-nerve-stimulation-guided-regional-anesthesia

Hi Pravin! Thanks, you too!

Thank you!

Thank you very much!

Best of luck!

You're welcome!

Hey Claudia Friedrich! Thank you for the great suggestion. We will definitely put this on our list. Greetings to you and all your colleagues and make sure you subscribe to our channel so you don't miss these upcoming videos. Best Regards from NYSORA!!

@@nysoravideo thanks so much for your answer! Your teaching videos are brilliant and I keep looking at them with my peers and show them to my students. Do you maybe also plan a little regional anesthesia crash course of the most important blocks for what a fellow should be able to cover? I am actually moving to NYC for a clinical fellowship at Columbia University starting this July! Would be great to visit the NYSORA studios, if possible? How to get in touch? If you have a business email to reach out, I’ll respond soon. Greetings from good old Europe (currently Switzerland) 😁 sincerely, Claudia

Very welcome!

Most Welcome Nelva! Make sure you subscribe to the channel so that you do not miss some super educational upcoming videos!

Hi Leresse! Great suggestion! Greetings from NYSORA!

As told in the video, you can start to see arrhytmias when the guide wire is touching the right atrium. Of couse the patient needs to be ECG monitored during the procedure because of this. When you see arrhytmias, don't go forward, instead you can pull the wire out a few millimeters.

By all means. THere is no ONE single best technique. The videos and techniques we post are aimed at 80% of folks, but there are always more way of doing things. Best regards

Any time! Thank you for watching. Do subscribe to this channel and share with your colleagues; a lot more videos are coming up soon. Greetings from NYSORA!

Will DO just that in what of our next videos soon.

A good technique to use is to try passing the wire through the catheter before even touching the patient, to ensure that the lumens are open and that there are no factory faults in the catheter and then start the actual procedure. If after vein punction the wire doesn't pass smoothly, you need to check the needle placement again with the ultrasound to make sure you are still in the internal jugular vein and that the needle hasn't moved or that you haven't accidentally went through the opposite wall of the vein, either with the needle or the guide wire (if the angle of the needle is really steep). Also make sure that the open end of the tip of the needle is facing "up" and not against the wall of the vein so that the guide wire has a clear path to go forward.

Mansoor, that is some attention to detail! Thank you for picking this up - we will fix next go around. These videos are not scripted, so sometimes in the multitasking of presentation, the brain slips up. Very best regards and keep in touch.

I totally agree!

Can you please describe in more details what do you mean by “in plane with oblique needle technique” ?

Thank you Sebastian. Indeed, watching the video - it looks that way. A couple of colleagues, also commented the same, but then, when re-recorded the procedure - no single recording looked any better - less bloody. If you do have one, please send along to admin@nysora.com and we will feature it. Best regards

No

Hi Enrique! Would you care to share your experience? We're always happy to hear from our viewers. Kind regards from NYSORA's team.

I agree. I like to see the tip at all times with either a tilt or creep maneuver. The anatomical location of the IJ to the carotid isn’t always a slam dunk.

Thank you for your feedback. We would love for you & our subscribers to submit their own videos of better ways of doing things to info@nysora.com and we will feature them on our channel. We love the opportunity to improve upon by seeing better examples. Best regards. #1 NYSORA Team.

@@kentewing2 Thank you for the feedback. Theoretically - you are correct. Indeed, ultrasound can be used for more aspects of the central line placement - from needle puncture, to monitoring needle path, to monitoring guidewire and catheter insertion. The use of ultrasound to 1) identify the position and size (filling) of the IJ is a skill that can be acquired relatively quickly. Knowing the position of the IJ alone - will substantially decrease the # of "dry punctures, and inadvertent carotid artery punctures, even if the ultrasound is not used for needle guidance. 2) Monitoring of needle (tip) advancement during IJ cannulation is the 2nd most valuable aspect of ultrasound guidance. However, this requires a lot more skill than #1, as stated in the video at 00:55 sec. 3) Monitoring guidewire and catheter insertion real time on US requires even more skill. The reality is that level of expertise and hand-eye coordination for safety with #2 and #3 is high and often not present. As an educator who teaches trainees and colleagues on a daily basis, I witness "overshooting" with needles during peripheral nerve blocks due to the loss of needle-tip position all the time. With nerve blocks, it is usually no-harm done - the needle ends up deeper in the tissue, it is recognized by the location of the injectate and correction is easy. However, with the central line - loosing track of the needle tip while relying on ultrasound can lead to serious complications, pneumothorax etc. This is why I personally prefer for most trainees that they use only step #1 and forgo ultrasound for #2 and #3. Finally, I respectfully disagree with labeling the operator's technique "sloppy". In fact, the video shows a very high degree of skill, control, dexterity, experience, and speed. This video is minimally edited - so what you see is the reality. Admittedly, the operators' large hands and some blood in the field deduct from elegance, but the best way to put this into context of one's perception of own technique is to record oneself. Many times we think we do things much better than what is documented on a recorded video. Playback of recorded videos is also an amazing tool to improve upon. Greetings and many thanks for watching the channel and commenting.