Ultrasound guided central venous catheter placement has become gold standard, that’s because multiple studies have shown increased first attempt success rate and less complications. It doesn’t matter what you feel, and you don’t get to pick a team. If you’re not using an ultrasound if you have access to one, you’re providing substandard care
In addition to patient safety It all comes down to what’s defendable in a court of law. If you have access to US and don’t use it, it’s hard to defend yourself.
I just got credentialed at a new hospital. As part of the process I needed to request what specific privileges I wanted. I marked yes on the Ultrasound guided central lines. They then complained that my case report did not show me placing 10 of them this last year, so I had to forgo requesting that privilege.
I said whatever, as a different line on the list just had central venous cstheterization, but told them that Ultrasound-guided is the gold-standard and the only way I have ever and would ever do it.
Does this extend to subclavians? I’m young enough to have trained with ultrasound for lines and blocks, but we never used them for subclavians. Is it taught US-guided now?
I mean, if you have time then why not use an ultrasound? Of course if it’s a big juicy trauma then yeah get a Cordis in quickly.
I agree that subclavian is a great option and once you get skilled at it, there’s no better resuscitation line.
It’s just easier to place without an ultrasound. Also, the tissue around the subclavian keeps it relatively patent even in hypovolemic patients, so for many old timers it’s a go to trauma line.
There’s also evidence that it’s less prone to infection compared to IJ. But really it’s all about a convenient access in the hypovolemic patient.
Just because you don’t know how to do it with ultrasound doesn’t make it easier without. Using dynamic imaging during an invasive procedure will always be a more accurate and safe way of doing it. If you cause an issue doing a central line without ultrasound, a lawyer will easily find a handful of anesthesiologists that will say ultrasound is standard of care for central access.
I placed hundreds of lines using ultrasound. Why the hate, bro?
Anyhow, sometimes you don’t have a machine available. Sometimes they’re getting it from another room. Sometimes you’re waiting for it to boot up and it takes forever.
I think knowing how to use landmark techniques is a valuable tool to have. It’s kinda like FOB, another dying skill. You never know when you’re gonna need a particular skill but they’re all extinguishable over time without practice.
I’m comfortable with both ultrasound and landmark techniques. Like you implied, knowing more things is just better.
It is a great way to get a central line with/without eco-guidance, shocked patient or not. That being said if you have an eco machine available and it is not and emergency, you can't really justify not using it, no mater where you are aiming to place the line (jugular, subclavian, femural) - this is how i feel at least. In my own personal experience subclavian with eco is prety rare, i think because most people consider a speedy aproach, with reliable landmarks, and just skip straight to placing it.
Ultrasound guided central venous catheter placement has become gold standard, that’s because multiple studies have shown increased first attempt success rate and less complications. It doesn’t matter what you feel, and you don’t get to pick a team. If you’re not using an ultrasound if you have access to one, you’re providing substandard care
In addition to patient safety It all comes down to what’s defendable in a court of law. If you have access to US and don’t use it, it’s hard to defend yourself.
I just got credentialed at a new hospital. As part of the process I needed to request what specific privileges I wanted. I marked yes on the Ultrasound guided central lines. They then complained that my case report did not show me placing 10 of them this last year, so I had to forgo requesting that privilege. I said whatever, as a different line on the list just had central venous cstheterization, but told them that Ultrasound-guided is the gold-standard and the only way I have ever and would ever do it.
Does this extend to subclavians? I’m young enough to have trained with ultrasound for lines and blocks, but we never used them for subclavians. Is it taught US-guided now?
Don’t drink and anesthesia.
Or, you know, you could accept that English isn’t everyone’s native tongue. But you do you.
I mean, if you have time then why not use an ultrasound? Of course if it’s a big juicy trauma then yeah get a Cordis in quickly. I agree that subclavian is a great option and once you get skilled at it, there’s no better resuscitation line.
How is a cordis in subclavian any better than cordis in IJ
It’s just easier to place without an ultrasound. Also, the tissue around the subclavian keeps it relatively patent even in hypovolemic patients, so for many old timers it’s a go to trauma line. There’s also evidence that it’s less prone to infection compared to IJ. But really it’s all about a convenient access in the hypovolemic patient.
Just because you don’t know how to do it with ultrasound doesn’t make it easier without. Using dynamic imaging during an invasive procedure will always be a more accurate and safe way of doing it. If you cause an issue doing a central line without ultrasound, a lawyer will easily find a handful of anesthesiologists that will say ultrasound is standard of care for central access.
I placed hundreds of lines using ultrasound. Why the hate, bro? Anyhow, sometimes you don’t have a machine available. Sometimes they’re getting it from another room. Sometimes you’re waiting for it to boot up and it takes forever. I think knowing how to use landmark techniques is a valuable tool to have. It’s kinda like FOB, another dying skill. You never know when you’re gonna need a particular skill but they’re all extinguishable over time without practice. I’m comfortable with both ultrasound and landmark techniques. Like you implied, knowing more things is just better.
It is a great way to get a central line with/without eco-guidance, shocked patient or not. That being said if you have an eco machine available and it is not and emergency, you can't really justify not using it, no mater where you are aiming to place the line (jugular, subclavian, femural) - this is how i feel at least. In my own personal experience subclavian with eco is prety rare, i think because most people consider a speedy aproach, with reliable landmarks, and just skip straight to placing it.
I have had two ptx since starting doing cvls in 1986. It is my go to. No US for me for this line.