18 gauge angiocatheter to IJ?

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GA8314

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Anyone ever do this as temporary in OR?
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do u mean EJ? or are you putting a long 18 in the IJ blind?

If you have US, Long 14 > long 18 for big cases.

If you're in an emergency i guess 18 to IJ is the superior option.
 
dchz said:
do u mean EJ? or are you putting a long 18 in the IJ blind?

If you have US, Long 14 > long 18 for big cases.

If you're in an emergency i guess 18 to IJ is the superior option.
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No. This was a vasculopath and I could not easily see an EJ (African American guy) visually OR under US. But he IJ was huge. US used of course. Should have grabbed larger, but 18 G was most handy. So, i put the long 18 in (wasn't really fat but felt long was still better).

Didn't want to put a 2 or 3 lumen CV line in because surgeon was going to place an Ash Cath after the thrombectomy.... So, just used angiocath. Only did it once before and usually go to EJ (which was original plan btw).
 
IMO it has to be a long catheter for either EJ or IJ.... I mean you can get by with a regular catheter, but as soon as that patients neck moves one way or the other you run a serious risk of infiltrating lots of fluids in the neck or mediastinum because the catheter came out.
Had an M&M during residency where this exact scenario happened: 18G IJ for a whipple... dumped 4 liters of crystalloids into the mediastinum = not good.
 
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In a pinch like Noy says, it is more than acceptable. If and when I do this (hardly ever), I am constantly drawing back to make sure I am getting heme.
If you are not getting any RBCs back into your syringe or tubing, then pull it and start over with a longer angiocath/cvl... don't try to fix it.
 
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sevoflurane said:
IMO it has to be a long catheter for either EJ or IJ.... I mean you can get by with a regular catheter, but as soon as that patients neck moves one way or the other you run a serious risk of infiltrating lots of fluids in the neck or mediastinum because the catheter came out.
Had an M&M during residency where this exact scenario happened: 18G IJ for a whipple... dumped 4 liters of crystalloids into the mediastinum = not good.
Click to expand...

Thanks man. Great input.
 
a buddy of minne suggested 14g long catheter under US with 3 or 4 stopcocks or use a multiport connector attached to use it just like a big catheter. i thought it was a great idea if they are working near the IVC so the central line might get in the way.

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If you're talking a 2" 18g catheter, sure. Or a 16. Or a 14. In a pinch. Never actually had to do this.

The 1.25" catheters won't cut it...for obvious reasons.
 
Spider sense was going off saying... we've already discussed this at some other moment in time.
Been on here since 2003... wow... time flies. Kinda cool to dig up old posts.

EJ Central Line
 
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long 14g to EJ gets you out of trouble sometimes. the kind of patients i put them in don’t move their necks ... or anything else
 
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Did this twice in residency with 14g 2" catheters. anatomic technique and 'transduced' with pressure tubing before hooking up the fluid.
 
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sevoflurane said:
IMO it has to be a long catheter for either EJ or IJ.... I mean you can get by with a regular catheter, but as soon as that patients neck moves one way or the other you run a serious risk of infiltrating lots of fluids in the neck or mediastinum because the catheter came out.
Had an M&M during residency where this exact scenario happened: 18G IJ for a whipple... dumped 4 liters of crystalloids into the mediastinum = not good.
Click to expand...

How did a short 18G catheter manage to dump 4L into mediastinum. How did it fit 4Ls???? How was the IV bag even flowing..

If you need a shorter catheter than central line, but longer than a IV, why not just put a RIC in the IJ?
 
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Put a proper central line in the IJ. Why f*** around? I see no advantage to an 18g IV. I do a lot of 14gx15cm single lumen catheters.
 
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introcan is the brand of the really long 18 G catheter we have. Has to be close to 3 inches. The concern would probably the catheter moving out of the vein if its too short. Must be faster/less cumbersome to put in the 18 G as opposed to a TLC.
 
There are a number of commercially available 5-6" single lumen catheters available that are great for short term use.
 
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anbuitachi said:
How did a short 18G catheter manage to dump 4L into mediastinum. How did it fit 4Ls???? How was the IV bag even flowing..

If you need a shorter catheter than central line, but longer than a IV, why not just put a RIC in the IJ?
Click to expand...

I don’t remember the exact details of this M&M except for the bullet points.
Short 18G and YES the mediastinum can hide quite a bit of fluid especially for long cases like the whipples that were done 10 years ago.
You can do a RIC if you want, but if I’m thinking of a RIC I am putting in an introducer/MAC.
I have never put a RIC in an IJ and I work at a regional trauma center where I am called upon to get big access quickly. I am sure it is fine, but if you are using it for major access there is nothing better than a MAC catheter except for maybe a large caliber dialysis catheter.
If you don’t need it for resuscitation, then a long catheter is absolutely fine. Patients don’t appreciate a big cordis in their neck when all they need is a good working IV.

Agree with JWK with respect to long angiocaths that are available.
 
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sevoflurane said:
I don’t remember the exact details of this M&M except for the bullet points.
Short 18G and YES the mediastinum can hide quite a bit of fluid especially for long cases like the whipples that were done 10 years ago.
You can do a RIC if you want, but if I’m thinking of a RIC I am putting in an introducer/MAC.
I have never put a RIC in an IJ and I work at a regional trauma center where I am called upon to get big access quickly. I am sure it is fine, but if you are using it for major access there is nothing better than a MAC catheter except for maybe a large caliber dialysis catheter.
If you don’t need it for resuscitation, then a long catheter is absolutely fine. Patients don’t appreciate a big cordis in their neck when all they need is a good working IV.

Agree with JWK with respect to long angiocaths that are available.
Click to expand...

Do you remember the flow rates to a MAC? i think a 8.5 ricc is about 1L/min but i dont remember what it is for MAC.
 
anbuitachi said:
Do you remember the flow rates to a MAC? i think a 8.5 ricc is about 1L/min but i dont remember what it is for MAC.
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Not off the top of my head... but it handles a Belmont beautifully.
It's utility is in the fact that it is a 9 French introducer AND a separate 12 gauge lumen that is also a high flow volume/pressor line. To boot, you can float a swan through it increasing your ability to deliver a variety of pressors through the PA cath AND use the 9 French and 12 gauge lumen as volume lines. It's my go to when I get the thoracic GSW, Train vs pedestrian, Ruptured AAA, etc.
 
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To put it into context... I've given 100+ units of blood products through a MAC catheter in an attempt to keep a young patient alive during a massive trauma. The MAC catheter was literally a life saver and very easy to use. Perfect access for massive trauma cases.
 
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I probably would've just put a CVP in and discussed with the surgeon. I'm not entirely sure what the catheter he was going to put in after the thrombectomy is so I'm not sure how "in the way" if at all an IJ CVP would be. As noted, for me it's the fear of infiltration.
 
sevoflurane said:
Not off the top of my head... but it handles a Belmont beautifully.
It's utility is in the fact that it is a 9 French introducer AND a separate 12 gauge lumen that is also a high flow volume/pressor line. To boot, you can float a swan through it increasing your ability to deliver a variety of pressors through the PA cath AND use the 9 French and 12 gauge lumen as volume lines. It's my go to when I get the thoracic GSW, Train vs pedestrian, Ruptured AAA, etc.
Click to expand...

My favorite central line, by far.
 
I use the one in the CVC kit to do a fabian, but that's it. Other than that, it I'm poking the IJ, it's because a central line is going in.
 
sevoflurane said:
Not off the top of my head... but it handles a Belmont beautifully.
It's utility is in the fact that it is a 9 French introducer AND a separate 12 gauge lumen that is also a high flow volume/pressor line. To boot, you can float a swan through it increasing your ability to deliver a variety of pressors through the PA cath AND use the 9 French and 12 gauge lumen as volume lines. It's my go to when I get the thoracic GSW, Train vs pedestrian, Ruptured AAA, etc.
Click to expand...

Correct me if I’m wrong, but I believe putting things through the introducer of a MAC (e.g. SWAN, SLIC, etc) decreases the lumen diameter of the 9fr port significantly. It’s still a great volume line even with something in the introducer, but if you want large amounts of volume, maybe avoid the putting anything in the introducer.
 
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GA8314 said:
Anyone ever do this as temporary in OR?
Click to expand...

I've done it with the 6.35cm 18ga introducer needle from the central line kit. It's more expensive than a long (1 3/4 in) angiocatheter but I do it so rarely it doesn't add up to much.
 
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Airlife91 said:
Correct me if I’m wrong, but I believe putting things through the introducer of a MAC (e.g. SWAN, SLIC, etc) decreases the lumen diameter of the 9fr port significantly. It’s still a great volume line even with something in the introducer, but if you want large amounts of volume, maybe avoid the putting anything in the introducer.
Click to expand...
You’re not wrong.

Putting a Swan through the introducer of a MAC dramatically decreases flow through the side port.

We do ANH for some of our cardiac cases (typically 450 mL x2 into citrate bags) and pull that blood off the MAC. If I’m also inserting a PA catheter at the same time the line gets placed, the PA cath only goes in a couple cm, otherwise the ANH takes forever. PA cath gets floated after the blood is out.
 
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pgg said:
You’re not wrong.

Putting a Swan through the introducer of a MAC dramatically decreases flow through the side port.

We do ANH for some of our cardiac cases (typically 450 mL x2 into citrate bags) and pull that blood off the MAC. If I’m also inserting a PA catheter at the same time the line gets placed, the PA cath only goes in a couple cm, otherwise the ANH takes forever. PA cath gets floated after the blood is out.
Click to expand...

We do the same...but usually float the Swan while the drape is still up from putting the line in. Then we pull off blood later...doesn't take a ton of time and its usually off before incision. I usually pull blood off from the white (12g) port, and the brown (9fr) port is hooked up to a fluid/warmer line. Granted...this is at an academic center where I have quite a bit of time to do all of this...whereas in PP I'd assume incision would've occurred much quicker.
 
The IJ isn’t a bad place for a single stick blood draw, either. If a patient has poor peripheral veins and/or the arms aren’t easy to reach ... the neck is right there. For some reason it freaks the nurses out when I do that.
 
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Arch Guillotti said:
What's a fabian?
Click to expand...
Basically a poor man's on the fly CVP. After the over-the-needle catheter is in the vessel, connect a piece of IV tubing (the Cordis kits we use come with a piece, otherwise, I just throw one) and allow it to fill with blood. I frequently just connect a syringe and fill it, but I think you are actually supposed to let it lie on the field and fill passively. One the tubing is full, hold it up perpendicular to the floor; if the catheter is venous it will fall back to the CVP, if arterial, you can pain the ceiling. Quicker than a blood gas, probably as reliable as scanning the vessel for the wire.

Here is a link to a better description.
 
Physio Doc 2 Be said:
Basically a poor man's on the fly CVP. After the over-the-needle catheter is in the vessel, connect a piece of IV tubing (the Cordis kits we use come with a piece, otherwise, I just throw one) and allow it to fill with blood. I frequently just connect a syringe and fill it, but I think you are actually supposed to let it lie on the field and fill passively. One the tubing is full, hold it up perpendicular to the floor; if the catheter is venous it will fall back to the CVP, if arterial, you can pain the ceiling. Quicker than a blood gas, probably as reliable as scanning the vessel for the wire.

Here is a link to a better description.
Click to expand...

Poor man’s CVP.
 
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