#ultrasound guided #subclavian central line insertion. Long-axis IP needle insertion by shrug technique as per @PulmCrit. Skin-to-posterior wall distance was 3.5cm, to prevent posterior wall puncture&pneumothorax, 3.25mm 18G PIV cath used instead of the 73mm CVC needle #POCUS
after succesful puncture, the needle was withdrawn leaving the sheath insitu. Guidewire then inserted. Even without #ultrasound monitoring, one can be sure that the posterior wall&pleura will no be pricked during excessive movement during guidewire insertion.
guidewire sliding down the ipsilateral brachoocephalic vein, confirming correct positioning. #POCUS #Anesthesiologist #FOAMed
gentle insertion of dilator
pt & families consented for anonymous publication
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