tag:blogger.com,1999:blog-4968787219619380438.post6732531610480469174..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: Ultrasound-Guided Central Venous Catheter InsertionSkeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-4968787219619380438.post-87140934223613710232013-12-14T20:15:58.233-05:002013-12-14T20:15:58.233-05:00I'm not going to argue about 0.3 mm. Thanks fo...I'm not going to argue about 0.3 mm. Thanks for commenting.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-85936268478437355102013-12-14T19:58:36.914-05:002013-12-14T19:58:36.914-05:00I thought that French was the diameter in mm times...I thought that French was the diameter in mm times pi(3.14) which is the CIRCUMFERENCE in mm. So an 18 Fr catheter is 18mm circumference.<br />So the diameter is 18mm divided by 3.14 which equals 5.7mm. Hence an 18 Fr catheter is 5.7 mm in diameter. As a vascular surgeon, I have done probably thousands of central lines. No question in my mind is that ultrasound for jugular catheterization is much safer and easier. However, for subclavian I think it is very hard to see the subclavian vein under ultrasound. And you are right about the 7 Fr catheter being 2.3 mm in diameter----7mm divided by 3.14 = 2.3 mm.<br />French is the circumference of the catheter in mm. <br />bigjimricottahttps://www.blogger.com/profile/04476836197646644643noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-62760962056434922212011-08-04T12:46:41.687-04:002011-08-04T12:46:41.687-04:00Joe-
I don't know where you read that 1 French...Joe-<br />I don't know where you read that 1 French is the size of a human hair.<br /><br />It is actually 1 Fr = 0.22 mm. 18 Fr = 6 mm in diameter.(http://en.wikipedia.org/wiki/French_catheter_scale)<br /><br />Most central venous catheters are about 7 Fr or 2.3 mm in diameter.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-25828571671746677492011-08-04T11:47:03.233-04:002011-08-04T11:47:03.233-04:00I read that the catheter is measured in Fr’s and o...I read that the <a href="www.180medical.com/catheters.aspx" rel="nofollow">catheter</a> is measured in Fr’s and one Fr is approximately the size of a human hair. The standard catheter is 18 Fr, so that would mean it’s about the size of 18 hairs in a bundle? That doesn’t seem like much.<br /><br />Is the Ultrasound-Guided Central Venous Catheter more or less the same size?Joehttps://www.blogger.com/profile/04863235602434124462noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-19109656441270981282011-06-23T11:55:33.034-04:002011-06-23T11:55:33.034-04:00The research on the utility of US guidance for cen...The research on the utility of US guidance for central venous access at the IJ is a little sparse recently. This is because of a lot of the data shows that it has reduced mechanical complications, reduced failures rates, and improved first pass success.<br /><br />The problem in using success as your clinical end point is that we are not good at giving up. Eventually the line will be done but the cartoid may have been tagged a few times or there is a large hematoma.<br /><br />Combining the data from multiple studies have led to the reccommendations from the AHRQ, CDC, CMS (all US) and NICE (UK) that US be used in realtime for IJ placement.<br /><br />Even the American College of Surgeons have agreed in their update.<br />http://www.facs.org/fellows_info/statements/st-60.html<br /><br />The most recent was from teh CDC that reccommended the use of US to prevent multiple passes to help prevent CLABSI.<br /><br />However, all of these reviews are predicated on the assumption that US guidance is being performed well and in experienced hands.<br /><br />When I trained from Internal Medicine I learned to perform the IJ with landmark techniques. Then I learned US, and it is a big difference and much safer for patients. The research is starting to focus on subgroups of people/conditions or refining techniques eg. thrombocytopenia and malignancy or infection or in plane vs out of plane, etc.<br /><br />I also agree with the difficulty note about skill refinement on the non-difficult patient to allow good technique and success in the difficult case. But the caveat is that only a handful of people are acutally how Netter drew them (22.2% per AC Gordon JVIR Vol 9 no2 333-338). So based on external appearance we don't know who will be difficult in reality until the landmark fails.<br /><br />As a related aside the FAUST study from the ACC supported US use for femoral arterial catheterization as a reduction in complications and time to cannulation.<br /><br />Jason NomuraTakeokunhttp://takeokun.comnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-41764975813808222322011-06-23T08:22:28.400-04:002011-06-23T08:22:28.400-04:00The Best Bets paper you mentioned states the follo...The Best Bets paper you mentioned states the following:<br /><br />“In patients with a potentially difficult central line insertion, the Ultrasound technique reduces complications and time to insertion. However in those patients where no difficulty is predicted, there is no evidence that the ultrasound technique confers any advantage.” My comment is that one must become facile with the ultrasound technique on the less difficult cases. Then the tough ones won’t be so tough.<br /><br />Here are two other references:<br /><br />Current Concepts: Preventing Complications of Central Venous Catheterization. <br />McGee, David C.; Gould, Michael K. New England Journal of Medicine. 2003;348:1123-1133<br /><br />“In hospitals where ultrasound equipment is available and physicians have adequate training, the use of ultrasound guidance should be routinely considered for cases in which internal jugular venous catheterization will be attempted.”<br /><br />Real-Time Ultrasonographically-Guided Internal Jugular Vein Catheterization in the Emergency Department Increases Success Rates and Reduces Complications: A Randomized, Prospective Study. Leung, Julie MBBS, BSc; Duffy, Martin MBBS; Finckh, Andrew MBBS, BA. Annals of Emergency Medicine. 2006;48:540-547<br /><br />“Conclusion: Ultrasonographically guided internal jugular vein catheterization in the ED setting was associated with a higher successful insertion rate and a lower complications rate.”Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-60748874950852808352011-06-23T00:39:08.400-04:002011-06-23T00:39:08.400-04:00I'm exactly the same as Cliff Reid - but less ...I'm exactly the same as Cliff Reid - but less experienced, less knowledgeable, and less English (only half!).<br />However, if we're talking about evidence base, for predicted 'easy' ultrasound I would probably have to concede that there seems to be little evidence that US is beneficial (is there anything new that invalidates the conclusion of this 2004 BestBETs review?: http://www.bestbets.org/bets/bet.php?id=213). Nevertheless, I will always at least look with the probe if its available - human bodies rarely read textbooks, so landmarks are only so helpful, and sometimes the size of vessels can be ridiculously different between right and left.<br />Chris Nicksonprecordialthumphttp://lifeinthefastlane.comnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-35589502412900944092011-06-22T17:08:18.644-04:002011-06-22T17:08:18.644-04:00I've been doing central lines since 1993, but ...I've been doing central lines since 1993, but only used ultrasound since 2004. I'm with you - I don't do them now without having at least placed the US probe on the patient to confirm the anatomy. The exception for me at the moment is subclavian lines, which I don't routinely US.<br /><br />CliffCliff Reidhttp://resus.menoreply@blogger.com