US IV question

[pgg]

I definitely am better with ultrasound than without, but even without ultrasound, I have higher first stick success compared to some residents using ultrasound, does that mean I should never let them learn or practice arterial lines.

?

It means you should teach them the safest and most effective way to do something.


This idea of purposely handicapping learners by teaching old or blind techniques, because maybe they'll need to do it without an ultrasound machine, is weird.

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[GassYous]

?

It means you should teach them the safest and most effective way to do something.


This idea of purposely handicapping learners by teaching old or blind techniques, because maybe they'll need to do it without an ultrasound machine, is weird.


View attachment 385444

Makes sense because when they have a bloody secretion filled airway, they need to be facile with video laryngoscopy as that has the best first past success rate

 

[T-burglar]

You sound like an absolute delight to work with. Would never call you for help. I am my own help.

What does that mean? You help yourself finally get the a line with an arm that looks like it went through a sewing machine?

 

[anaesthetic]

For art do you look for flash or do you use the donut/walk the needle technique?

I walk it in. You can still get flash with sidewalling/backwalling the artery, so it’s less reliable than looking at the image, IMO. That being said, I look for flash to confirm the needle is intraluminal (tenting the vessel without puncturing through looks similar on US).

 

[DrN2O]

For art do you look for flash or do you use the donut/walk the needle techniqu

Yes, this is the next battle to fight. I admit that the US/landmark battle is already lost.

I walk it in. You can still get flash with sidewalling/backwalling the artery, so it’s less reliable than looking at the image, IMO. That being said, I look for flash to confirm the needle is intraluminal (tenting the vessel without puncturing through looks similar on US).

This deserve its own thread. But I think we did it already:

Large Vessel Arterial Pressure Monitoring

SDN Anesthesia Hivemind-- What is your threshold for gaining large-vessel arterial access in patients with significant (or significant anticipated) vasopressor requirement? There's obviously some (albeit not a huge volume) of data showing a significant discrepancy between radial arterial...

forums.studentdoctor.net

 

[pgg]

This deserve its own thread. But I think we did it already:

Large Vessel Arterial Pressure Monitoring

SDN Anesthesia Hivemind-- What is your threshold for gaining large-vessel arterial access in patients with significant (or significant anticipated) vasopressor requirement? There's obviously some (albeit not a huge volume) of data showing a significant discrepancy between radial arterial...

forums.studentdoctor.net

There was good discussion in that thread

It seems we failed to convince you there, too.

 

[nimbus]

I also use US for 99% of art lines. The 1% is for the in-the-room, cut-skin-now traumas that I no longer do.

And when the SBP is <60 in these traumas and you get no flash or a very slow flash, ultrasound is exceptionally helpful. In that situation I often just trust the ultrasound.

 

[Drwine]

I definitely am better with ultrasound than without, but even without ultrasound, I have higher first stick success compared to some residents using ultrasound, does that mean I should never let them learn or practice arterial lines.

I have always joked around that I am going to have a heritage toy store mail the residents we match a box of Pick Up Sticks with the instructions that when they are able to win that game they have the appropriate feel for me to teach them invasive monitoring.

 

[coffeebythelake]

If it was your radial artery, would you want an extra hole or two in it, or would you rather the anesthesiologist just one-stick it dead center with ultrasound?

I'm not saying people can't be good with blind art lines, but they can't ever be as good as they'd be with ultrasound. This is self evident.

If you're good, why not be better?

Haven't you heard the saying.. "the enemy of good..."??

 

[pgg]

Haven't you heard the saying.. "the enemy of good..."??

In case you're being serious -

It's a saying that means incremental efforts to become better can turn something good, bad. Either directly by messing up a good thing, or indirectly by wasting resources chasing marginal utility.

Completely inapplicable to the question of using ultrasound for lines.

 

[T-burglar]

Jesus Christ what??

Do you do much worse with this procedure when using an ultrasound? I don’t understand your usage of “the enemy of good” here

If that’s the case and you butcher an arm when using ultrasound then I guess it all starts to make sense

 

[coffeebythelake]

Yes I'm just messing with you.

I do most of my art lines by palpation technique and have 95% first attempt success rate. I don't go through and through either. Why don't I use ultrasound for everyone? Because we don't have one for every room and often times it is being used for someone else. So unless I want to make a 1 min procedure into a 10 min procedure I just go palpation

Sickies, hypotensive, poor feel, anticoagulated and dysthythmias I have higher likelihood to go ultrasound

 

[DrN2O]

Jesus Christ what??

Do you do much worse with this procedure when using an ultrasound? I don’t understand your usage of “the enemy of good” here

If that’s the case and you butcher an arm when using ultrasound then I guess it all starts to make sense

Trust me, when done by a novice, with suboptimal US quality and under-appreciation of the US artifact/limitation, you can do a lot of things wrong. I speak from my own experience, I was very dangerous as a student with an US. Iso meant to say experienced users without US could be better than novice with US because they pay more attention to the flash, and techniques of threading and catheter advancement.

 

[medicine2wallstreet]

Man y'all act like putting in a radial artery requires the equivalent technique and experience of sewing in a new aortic valve.

Just put the damn thing in. Ultrasound in plane out of plane no ultrasound flip the bevel blah blah who cares.

It's a radial artery a line. This isn't cardiac surgery. Pgg included in my ire.

Do I prefer US because it's easier? Yes. Is it malpractice for my colleagues to do it blind? No.