How to Safely Cannulate a Difficult Internal Jugular Vein on the First Attempt

Indeed, checking blood return is an essential procedure in CV line placement. But, putting too much priority on flashback can hamper efforts to visualize the needle tip on US screen. For a deeper insight into this topic, please go to https://doi.org/10.1186/s41100-016-0019-1 and view my article: “Ultrasound-guided cannulation of hemodialysis access”. A nephrologist in Kyoto, Tadashi Kamata, MD Video Index: Click on the blue type below to jump to a specific stage of the video. 00:00 Start 1. 00:16 Background 2. 01:10 Transverse vs. longitudinal 3. 01:32 Probe holding 4. 02:31 Needle holding 5. 02:54 Determination of puncture site 6. 04:20 In the soft tissue 7. 07:09 Push & stick 8. 09:33 Needle blinking 9. 11:36 Guidewire identification 10. 12:30 Actual case 11. 17:20 Difficult cases 12. 20:26 Troubleshooting 13. 21:30 Needle 14. 22:49 Guidewire 15. 23:05 Ultrasound machine 16. 23:40 Simulation training 17. 24:00 Video recording *************** Relevant papers & videos *************** Three tips for improving the ultrasound visibility of the needle tip. https://youtu.be/7fxADjLICQ0 Thomas S, et al. “The vanishing target sign: confirmation of intraluminal needle position for ultrasound guided vascular access.” Acad Emerg Med. 2013 Oct;20(10):e17-8. https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.12228 Bondestam S. “The needle tip echo.” J Ultrasound Med. 1992;11:253-6 Kamata T, et al.“Ultrasound-guided cannulation of hemodialysis access. Ren Replace Ther” 2016; 2:7 https://doi.org/10.1186/s41100-016-0019-1 Kamata T, et al. “Visibility of guidewires in ultrasound-guided internal jugular double lumen catheterization” J Jpn Soc Dial Ther. 2012;45:475–82 (in Japanese). https://www.jstage.jst.go.jp/article/jsdt/45/6/45_475/_pdf Ultrasound Guided Internal Jugular Vein Cannulation NEJM https://youtu.be/hPPzFnGcLRs Rapid IJ (aka Easy Internal Jugular Cannulation) https://youtu.be/FjSmbUWXznY Internal jugular central line insertion https://youtu.be/fZyxzzn11QM Ultrasound-guided internal jugular cannulation (short-axis approach) https://youtu.be/PUyybCfli_E Ultrasound Guided Subclavian Central Lines -- BAVLS https://youtu.be/_VYHj4sRlkc Ultrasound guided peripheral venous cannulation in an actual patient https://youtu.be/8FnyzJzDYds