Anesthesia unplugged by Gallagher, Christopher J.

By Gallagher, Christopher J.

"An a laugh step by step method of studying easy anesthesia options and techniques. Written in a funny, wonderful sort, Anesthesia Unplugged, 2e is helping anesthesiologists in education advance the procedural abilities useful for the optimum care of the anesthetized sufferer. that includes an easy-to-navigate atlas-style presentation, the e-book covers all correct anesthesia approaches, detailing indications,  Read more...

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Locate the IJ and the relative anatomy, including the relational anatomy of the carotid artery. The IJ is frequently larger than, and lateral to, the carotid. However, the anatomy is highly variable. The carotid artery frequently demonstrates pulsatility, and the IJ should be easily compressible when pressure is applied to the US probe. Additionally, the IJ usually increases in size with maneuvers that increase preload. – Scan the area in a rostral-caudal axis to determine where the vessel presents itself most robustly (Figure 2-12).

Confirm wire placement within the IJ. Note that to visualize the wire, one needs to place the US probe caudal to the skin entry site (since the wire does not enter the vessel at the level of the skin penetration). You can rotate the US probe 90 degrees to view the wire/ vessel in the long axis. US has a near 100% sensitivity and specificity for wire placement confirmation 13 (Figure 2-19). Once the wire position has been confirmed, the catheter is advanced utilizing Seldinger technique, and secured as described above.

Efficiently and safely placing an IJ line is certainly one of them. You should be able to do this in your sleep, because you may have to! The IJ is most often the final common pathway to the heart for the cardiac anesthesiologist. It is utilized as a volume line, a drug push line, a vasoactive substance drip line, and as a conduit through which to place other catheters. Acquiring the skill to place an IJ line safely and efficiently is of paramount importance. This skill involves knowledge of the relational anatomy of the vessel, the various types of catheters that are available, complications and their management, and the use of ultrasound (US) techniques as they are applied to line placement, as well as basic catheterization skills.

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