Scalp IV for adults?

[ISoNitrous]

Hey gang,
I'm festering away in another knee, and this lady's forehead veins are calling my name. It's got me thinking -

In a jam (tucked arms, difficult IV access, etc.), have you ever utilized a scalp IV in an adult? I've done the shoulder or breast before, but never had the gall to stick a needle in the noggin.

Have you? Would you?

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[D4C]

Why scalp when there’s an EJ/IJ?

 

[T-burglar]

Sure, go nuts

 

[Guillemot]

Sounds like a boomer sort of thing to do. Better to learn how to use ultrasound.

 

[UscGhost]

Sure, go nuts

Scrotal IV?

 

[coffeebythelake]

Hey gang,
I'm festering away in another knee, and this lady's forehead veins are calling my name. It's got me thinking -

In a jam (tucked arms, difficult IV access, etc.), have you ever utilized a scalp IV in an adult? I've done the shoulder or breast before, but never had the gall to stick a needle in the noggin.

Have you? Would you?

My dude... use Ultrasound.
Or untuck the arms.

 

[patriot6]

i've used a scalp IV during a head transplant to keep the face perfused well

 

[Greenbayslacker]

Have used a scalp vein before:
Helping out with someone else's case, hip replacement, ultrasound-guided IV blew, several attempts by various docs & nurses in every extremity with and without ultrasound, only had access to one side of the neck, blew the EJ. Next step was to go supine and place IJ, but I gave the nice juicy scalp vein a shot with a 20g and it worked great. It dripped well & we gave some glyco as a test dose and it was definitely working.

They main question we had was the directionality of the vein. I ended up placing the cannula from more distal (towards the eyes) to more proximal (towards the hair). I'm sure there are veins that flow in a different direction.

 

[Arch Guillotti]

Next step was to go supine and place IJ

I placed a cordis in a patient in the lateral position once. Desperate times call for desperate measures.

 

[Coffee PRN]

Scrotal IV?

Just the tip? Or through and through?

 

[Iso4ane]

My dude... use Ultrasound.

On the scalp right?

 

[Anesthesia_Guy]

Hey gang,
I'm festering away in another knee, and this lady's forehead veins are calling my name. It's got me thinking -

In a jam (tucked arms, difficult IV access, etc.), have you ever utilized a scalp IV in an adult? I've done the shoulder or breast before, but never had the gall to stick a needle in the noggin.

Have you? Would you?

Epic stupidity.

 

[Maz777]

Hey gang,
I'm festering away in another knee, and this lady's forehead veins are calling my name. It's got me thinking -

In a jam (tucked arms, difficult IV access, etc.), have you ever utilized a scalp IV in an adult? I've done the shoulder or breast before, but never had the gall to stick a needle in the noggin.

Have you? Would you?

Who tucks arms for a TKA? Makes no sense.

 

[POW16]

Hey gang,
I'm festering away in another knee, and this lady's forehead veins are calling my name. It's got me thinking -

In a jam (tucked arms, difficult IV access, etc.), have you ever utilized a scalp IV in an adult? I've done the shoulder or breast before, but never had the gall to stick a needle in the noggin.

Have you? Would you?

No and I would not. So many better options.

 

[Angus Avagadro]

I have done it twice. Both in drug addicts with no veins who were "Allergic" to I V contrast and convinced a urologist to do a cysto/retro. I didn't want to put in a central line so they could sneak out AMA with it in place.

 

[PpfSuxTube]

Who tucks arms for a TKA? Makes no sense.

I don't think he means the arms are tucked for tka, just posing a hypothetical question.

Personally I wouldn't.

If you're in a bind you're gonna be given pressors probably epi, lots of fluid. Extravasation means very visible harm. Cosmetic issues would lead to a massive lawsuit against you I would think. Visible harm is much less likely to be defensible. I'd do EJ, blind subclavian, even blind IJ before acalp

 

[DocMcCoy]

Who tucks arms for a TKA? Makes no sense.

B/L robot?

 

[T-burglar]

I have done it twice. Both in drug addicts with no veins who were "Allergic" to I V contrast and convinced a urologist to do a cysto/retro. I didn't want to put in a central line so they could sneak out AMA with it in place.

Why go through all this trouble and liability exposure ? Did you really do this?

Just put a ****ing central line in, are you that uncomfortable with the procedure? Don’t say it’s because you were depriving them of the ability to leave AMA and use it to shoot up lol. That’s incredibly judgmental and presumptive and frankly weird that you’d let such a consideration dictate your care. If you can’t care for a patient properly because you dislike their moral choices that much you should hand the case off to someone that will render appropriate care

 

[Angus Avagadro]

Why go through all this trouble and liability exposure ? Did you really do this?

Just put a ****ing central line in, are you that uncomfortable with the procedure? Don’t say it’s because you were depriving them of the ability to leave AMA and use it to shoot up lol. That’s incredibly judgmental and presumptive and frankly weird that you’d let such a consideration dictate your care. If you can’t care for a patient properly because you dislike their moral choices that much you should hand the case off to someone that will render appropriate care

You are calling ME judgemental? Can you hear yourself? Maybe not, you're typing. Guess you have never had a drug addict sneak out of the hospital with an iv. It's an iv for a 15 min uro procedure. But do go on to instruct us all on the appropriate care and liability exposure that scares you so much.

 

[zizzer]

i've used a scalp IV during a head transplant to keep the face perfused well

Since the brain is in the head, wouldn't it be more accurate to think of it as a body transplant?

 

[patriot6]

I have done it twice. Both in drug addicts with no veins who were "Allergic" to I V contrast and convinced a urologist to do a cysto/retro. I didn't want to put in a central line so they could sneak out AMA with it in place.

the answer here is an ultrasound guided IV... not a face IV, lol

 

[zizzer]

Maybe I'm not following, but couldn't an IV drug user sneak out with any kind of IV? I'm not against scalp IVs per se, but that does seem like a weird reason to do one.

 

[markneil]

Hey gang,
I'm festering away in another knee, and this lady's forehead veins are calling my name. It's got me thinking -

In a jam (tucked arms, difficult IV access, etc.), have you ever utilized a scalp IV in an adult? I've done the shoulder or breast before, but never had the gall to stick a needle in the noggin.

Have you? Would you?

In a "jam" means an emergent situation with no other choice. If a scalp IV is there, fine; I would use use it more as a temporary line but I would like a more definitive and reliable access so central venous cannulation would be my best bet. Everyone should be able do them lateral or supine.

 

[zizzer]

In a "jam" means an emergent situation with no other choice. If a scalp IV is there, fine; I would use use it more as a temporary line but I would like a more definitive and reliable access so central venous cannulation would be my best bet. Everyone should be able do them lateral or supine.

I was consulted to place an emergency HD CVC on a "permaprone" COVID-19 patient who couldn't tolerate even brief supine position. Anybody ever placed a prone CVC?

 

[Anesthesia_Guy]

I was consulted to place an emergency HD CVC on a "permaprone" COVID-19 patient who couldn't tolerate even brief supine position. Anybody ever placed a prone CVC?

Yes. I had the R.N. hold a mirror over my shoulder and did it that way. I'm the bomb.

 

[coffeebythelake]

I was consulted to place an emergency HD CVC on a "permaprone" COVID-19 patient who couldn't tolerate even brief supine position. Anybody ever placed a prone CVC?

Can u even get to the neck?

 

[abolt18]

I was consulted to place an emergency HD CVC on a "permaprone" COVID-19 patient who couldn't tolerate even brief supine position. Anybody ever placed a prone CVC?

Popliteal vein? Could probably get a 7Fr in there.

 

[medicine2wallstreet]

You are calling ME judgemental? Can you hear yourself? Maybe not, you're typing. Guess you have never had a drug addict sneak out of the hospital with an iv. It's an iv for a 15 min uro procedure. But do go on to instruct us all on the appropriate care and liability exposure that scares you so much.

I like this Angus guy. He does real anesthesia to care for a patient. Not constantly pulls his hair out about what a lawyer would think. I agree with you Angus.

The extravasation comment that guy made is ridiculous. If you're that worried about extravasation he should mask people down exclusively on induction.

 

[T-burglar]

Another incredible comment from medicine 2 wall street

 

[zizzer]

Popliteal vein? Could probably get a 7Fr in there.

I didn't even consider that, but that's interesting. I was planning on doing my best with the neck turned to the side, but when I went to see the patient the patient had an AV fistula already but the nephrologist had said the patient was too unstable for IHD. All the instability was pulmonary with no vasopressors or inotropes other than inhaled pulmonary vasodilators so I told them it's much less risky to do IHD than inventing new medical procedures.

 

[PpfSuxTube]

I like this Angus guy. He does real anesthesia to care for a patient. Not constantly pulls his hair out about what a lawyer would think. I agree with you Angus.

The extravasation comment that guy made is ridiculous. If you're that worried about extravasation he should mask people down exclusively on induction.

It is indeed an honor to be on your ridiculous list...

 

[vector2]

2" long IV in the IJ with my butterfly all day before I'd consider anything as ridiculous as a scalp IV in an adult

 

[psycho-matic]

Have used a scalp vein before:
Helping out with someone else's case, hip replacement, ultrasound-guided IV blew, several attempts by various docs & nurses in every extremity with and without ultrasound, only had access to one side of the neck, blew the EJ. Next step was to go supine and place IJ, but I gave the nice juicy scalp vein a shot with a 20g and it worked great. It dripped well & we gave some glyco as a test dose and it was definitely working.

They main question we had was the directionality of the vein. I ended up placing the cannula from more distal (towards the eyes) to more proximal (towards the hair). I'm sure there are veins that flow in a different direction.

IO to get out of a bind?

 

[coffeebythelake]

2" long IV in the IJ with my butterfly all day before I'd consider anything as ridiculous as a scalp IV in an adult

How do u like the butterfly IQ?

 

[zizzer]

The butterfly IQ is convenient and plenty adequate for lines. I've used it for arterial lines, IVs, and even an emergency CVC. It's decent as a TTE but the probe footprint is larger than one of the good ones on wheels. Still, cool toy for the price if you get reimbursed for stuff like that.

 

[Sriddymopboi]

2" long IV in the IJ with my butterfly all day before I'd consider anything as ridiculous as a scalp IV in an adult

Can I ask something? Why would you place a regular IV in the IJ? Why don't you just use a regular central line? What's the benefit to placing the IV over the central line in the IJ? Do you need to be sterile when placing the IV in the IJ or is it treated just like a regular IV?

 

[bourg]

I’ve put a 14G on the IJ once. Needed fluids quickly, arms were tucked. We don’t have Cordis, no MAC introducer, only triple lumen (which doesn’t achieve high flows).

 

[coffeebythelake]

Can I ask something? Why would you place a regular IV in the IJ? Why don't you just use a regular central line? What's the benefit to placing the IV over the central line in the IJ? Do you need to be sterile when placing the IV in the IJ or is it treated just like a regular IV?

Because it is much faster.

 

[triggermaster]

Since the brain is in the head, wouldn't it be more accurate to think of it as a body transplant?

Could be a trans-transplant depending on the choice of body.

 

[T-burglar]

If you’re going to access the central circulation without sterility then you should still just put an introducer in . Take it out when the crisis is over

 

[fakin' the funk]

Hey gang,
I'm festering away in another knee, and this lady's forehead veins are calling my name. It's got me thinking -

In a jam (tucked arms, difficult IV access, etc.), have you ever utilized a scalp IV in an adult? I've done the shoulder or breast before, but never had the gall to stick a needle in the noggin.

Have you? Would you?

No.

CVC or IO or US peripheral.

 

[medicine2wallstreet]

If you’re going to access the central circulation without sterility then you should still just put an introducer in . Take it out when the crisis is over

No. If you didn't need an introducer in the first place you don't need one when you lose access. Takes so much time. 18 gauge to IJ takes seconds.

And for all the big leaguers please spare me the line of "I'm the damn best there is it takes me 1 minute to do a central line start to finish git better kid".

 

[PpfSuxTube]

And for all the big leaguers please spare me the line of "I'm the damn best there is it takes me 1 minute to do a central line start to finish git better kid".

Why are you so slow?