Mike: That's a real nice review Matt
I just want to take a couple of seconds and make a couple of points.
I think you did a good job talking about the infraclavicular subclavian technique,
I just wanted to bring up the idea of the
supraclavicular US guided technique.
Matt: So, Mike's obviously taking about a recent little itty bitty released,
check it out if haven't already.
On another note, you may have recently noticed Mike's audio is about 1000x better than mine occasionally.
I know this is confusing because in real life Mike has the most annoying voice you ever heard,
so what happened is I just discovered that I had my microphone backwards for about the last 8 months
sorry about that.
Mike: So the supraclavicular technique has been described sort of as a pocket shot
it's usually used with the vascular endocavitary probe
and the basic concept is that you insert the needle at the confluence of the subclavian and the IJ.
When they form the brachiocephalic.
And this is typically best done on the right side
mostly because of the angle the brachiocephalic makes with the SVC
and directs towards the heart.
A little bit harder on the left side
the angle isn't quite as amenable to passing a wire, and there's also the thoracic duct that inserts on the left side.
SO this is typically performed on the right side of the patient's body.
The supraclavicular technique can be performed by first placing the probe on the patient's IJ
so you bascially start looking at the IJ as about to perform an IJ
Instead, you start moving the probe proximally
or down towards the chest
and basically angle the probe into the patient's chest,
and what you'll see is the SC and the IJ meet at a fairly sharp angle,
and then you can often see the brachiocephalic move away/down into the patient's chest.
So, when you perform it in this way, when you look at the IJ in the short axis,
you'll actually see the SC in long axis.
SO here's an example of what you might see,
so you can see how the probe sort of just over where the patient's IJ should be
but it's almost sitting on top of the clavicle
almost on top of the patient's angle of the mandible
and what you see here is the SC in long axis
it's about 2cm deep
it's a really easy shot from this angle
it's not very deep, and it's nice and big.
you can see how you're sort of aiming for where the SC dives down for the brachiocephalic
So we have the SC running in the long axis and the brachiocephalic diving down into the patient's chest.
So it's a pretty easy procedure,
you do have to do it in long axis, there's not really enough room in this area to do it in short axis.
This has also been described using the endocavitary probe
you can actually place the endocavitary probe in the SC fossa
sort of right up next to the clavicle and the SCM muscle
and point down into the chest, just like you would with the vascular probe
and you'll see in the same manner you'll see the IJ and the SC forming the innominate
keep in mind there is a valve there where the SC and the IJ connect together,
which you'll often see on US
nothing to worry about though,
you can pass the catheter straight through that area.
There's actually a recent soundbite case by Phil Perera on Supraclavicular SC vein cannulation
I thought he did a great job on this.
It's about 13minutes long so you should definitely check that out if you're interested in doing more SC SC procedures.
Matt: I really got nothing to add to that...other than this...
The next 2 people to register for castlefest2013 will get to place a SC central line in Mike.
Castlefest2013.com....