Put in my first IJ CVC from a long axis approach

[okayplayer]

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Pretty sweet. Been doing short axis the past 3.5 years but did an oblique/long axis view with the US today. Pretty sweet seeing the needle tip enter the vessel.

Any reason not to do this routinely (other than people with short necks)?

 

[Mman]

In some patients it can be difficult to tell that the vessel you are looking at in short axis is the vein and not the artery. Not good to watch the needle enter the artery. The problem with long axis is you only see the one vessel at a time. If you push down with the probe to make sure it is compressible, it is possible for the probe to slide slightly sideways and actually place you over the carotid instead.

The big benefit to short axis is that you always see both the carotid and the IJ. What you want to do then is get really good when you can just slide the probe in short axis further distal down the neck as you go so you can actually follow the tip of the needle into the vein while still in short axis. It's fairly advanced U/S use, but it's probably the best way to place an IJ line using the U/S IMHO.

 

[turkeyjerky]

Pretty sweet. Been doing short axis the past 3.5 years but did an oblique/long axis view with the US today. Pretty sweet seeing the needle tip enter the vessel.

Any reason not to do this routinely (other than people with short necks)?

Oblique or long axis? The two are distinct. See this The oblique view obviates a lot of the negatives of the long axis technique mentioned above, but its not commonly used.

 

[okayplayer]

I think it was oblique because I could see both IJ and carotid longitudinally (similar to the view I frequently obtain to confirm guide wire placement in the IJ).

 

[Bostonredsox]

In some patients it can be difficult to tell that the vessel you are looking at in short axis is the vein and not the artery. Not good to watch the needle enter the artery. The problem with long axis is you only see the one vessel at a time. If you push down with the probe to make sure it is compressible, it is possible for the probe to slide slightly sideways and actually place you over the carotid instead.

The big benefit to short axis is that you always see both the carotid and the IJ. What you want to do then is get really good when you can just slide the probe in short axis further distal down the neck as you go so you can actually follow the tip of the needle into the vein while still in short axis. It's fairly advanced U/S use, but it's probably the best way to place an IJ line using the U/S IMHO.

Agree. Much easier to cannulate in short axis. Then confirm it with short and long axis, following the wire down Into the vessel.

 

[RxBoy]

agree.. short access much easier and efficient. Obtaining long access views takes long time to aquire the image. First it has to be perfectly lined up and then trying to figure out which is the vein and which is artery. Sure you can probably get the image in 20 or so seconds if your quick, but thats 20 secs wasted.

On a radial a-line, if the vessel has a very narrow lumen, I tend to use the long axis approach. Its sometimes a pain to get into view, but since the target is so small, well worth it

 

[okayplayer]

Fine, you guys win. I am sure it would be faster for me to do it short axis since I'm pretty experienced at this point but it was kind of fun to do it the other way for a change of pace.

 

[BobBarker]

My fellow residents and I were trained to do IJs through an oblique view as interns. It is very safe and easy to do. I have completely abandoned it in favor of short axis solely due to having to deal with attendings who don't understand the technique.