Procedure Videos: Venipuncture

Preparation for Venipuncture


Performing Venipuncture

Uploaded by Slyswami.

Related:
Peripheral Intravenous Cannulation. NEJM Video in Clinical Medicine, 11/2008.
Bevel Dow. Musings of a Dinosaur.
Why I Do Blood Draws. Musings of a Dinosaur.

Updated: 06/022/2009

What to do if you lose a guide wire during central line placement?

I was discussing central line placement complications with medical students a few days ago. Some of them are illustrated with horrifying details in the NEJM.

"What should you do if you lose a guide wire during central line placement?", I asked.

"We could use a strong magnet to pull it out", one of the students suggested.

Well, not really.

You should call interventional radiology immediately and the radiologist will extract the wire under fluoroscopic guidance by using another wire to hook up and pull out the lost one.

A few examples of different approaches to extract lost guide wires are listed in the British Journal of Anaesthesia.

We have published free illustrated step-by-step procedure guides to central placement with and without ultrasound. The guides are available as web pages and Windows Mobile/Palm downloads.

References:
Central Line Placement: A Step-by-Step Procedure Guide with Photos
Loss of the guide wire: mishap or blunder? British Journal of Anaesthesia, 2002, Vol. 88, No. 1 144-146.
Lost guide wire during central venous cannulation and its surgical retrieval. Kumar S, Eapen S, Vaid VN, Bhagwat AR. Indian J Surg 2006;68:33-34.
Image source: Wikipedia, public domain.

Further reading:
Lost Guide Wire. Radiology Picture of the Day.
A Big Time Mistake. Ten out of Ten: My experiences as an ER doc, 02/2008.

Improper placement of the central venous catheter - case one and case two from the Annals of Emergency Medicine

Updated: 02/09/2010

Emded Procedure Slideshows from Google Photos

Google Photos (currently named Picasa Web Albums) added Flash slideshows which can be embedded in web sites. This new feature is demonstrated with some of our procedure guides below. You can choose the photo size: from small (144 px) to extra-extra large (800 px).


Thoracentesis: A Step-by-Step Procedure Guide with Photos


Central Line Placement: A Step-by-Step Procedure Guide with Photos


Central Line Placement with Ultrasound Guidance: A Step-by-Step Procedure Guide with Photos

Update 06/26/2007:
Picasa Web has a mobile version and map locations.


Online Photo Sharing in Plain English

References:
Picasa Web Albums introduces embeddable Flash slideshows. DownloadSquad.com.
Put your photos on a map, and Picasa on your phone. Official Google Blog, 06/2007.

Updated: 02/02/2008

Free Procedure Guides for Pocket PC/Windows Mobile and Palm

Two years ago, a colleague of mine and I made several procedure guides illustrating central line placement and thoracentesis with step-by-step photos:

Central Line Placement - A Procedure Guide

Central Line Placement with Ultrasound Guidance - A Procedure Guide

Thoracentesis - A Procedure Guide

These photo guides proved very popular and are currently used for teaching purposes by residents at Cleveland Clinic and Case Western Reserve University/St. Vincent, and are linked in Wikipedia among several other web sites.

Eight months ago, I got an email from Andrew Schechtman, a Clinical Instructor at Stanford University School of Medicine and the founder of MeisterMed, a popular PDA portal for medical references. Andrew wanted to know if I was interested in adapting the procedure photo guides to PDA and distributing them for free. The original idea behind the guides was that they should be free and used by residents and physicians all over the world, and his suggestion to adapt them for PDA fitted that idea perfectly. I thought about it but somehow never found the time to do it.

Anyway, the procedure guides for PDA are now available for free from MeisterMed:

Central Line Placement (with and without ultrasound guidance).
A Chapter in MeisterMed's Procedure Series for PDA.
V. Dimov, B. Altaqi, 2/20/2007.
Click to download (size: 3.7 MB).

Thoracentesis.
A Chapter in MeisterMed's Procedure Series for PDA.
V. Dimov, B. Altaqi, 2/20/2007.
Click to download (size: 1.6 MB)

The guides themselves are free but they need the iSilo program for Pocket PC/Windows Mobile or Palm to work. The full version of iSilo is required to see the images beyond the trial period and that version costs $ 19. The guides are just like Microsoft Word documents -- you need to have MS Word installed on your computer in order to see the documents. Similarly, you need iSillo installed on your PDA to be able to see the photo guides.

Procedure guides are part of the MeisterMed Procedure Series which will be adding more titles in the near future.

Central Line Placement Videos on YouTube

The videos below show "practical tips and tricks for central line placement in the ED." ClinicalCases.org has our own step-by-step procedure guides with photos:

Central Line Placement - Procedure Guide

Central Line Placement with Ultrasound Guidance - Procedure Guide

Without a doubt, videos are better than still photos in many ways. Photos have the advantage of being able to see clearly what is going on though. It is similar to comparing Flickr to YouTube (or Google Video) -- both are needed for a complete visual experience.


Central Line Placement, Part 1


Central Line Placement, Part 2


Central Line Placement, Part 3


Central Line Placement, Part 4


Central Line Placement, Part 5

Link via JTF wiki.

References:
Central Venous Catheterization: Concise Definitive Review. Medscape, Critical Care Medicine, 05/16/2007 (free registration required).
BioMed Central's You Tube channel: videos from BioMed Central's authors and editors, 09/2007.
NEJM Videos in Clinical Medicine. These are high-quality professional videos but they require a subscription to NEJM:
Central Venous Catheterization - IJ vein
Central Venous Catheterization - Subclavian Vein
Central Line

Related:
YouTube as a Source of Health Misinformation. Highlight HEALTH 2.0, 02/2008.
YouTube as a source of information on immunization: a content analysis. Keelan et al. JAMA. 2007 Dec 5;298(21):2482-4.

Updated: 02/06/2008

Clinical Procedure Guides on Picasa Web: Step-By-Step Photos

I have just moved the three procedures guides we created to Picasa Web Albums:

Central Line Placement - Procedure Guide

Central Line Placement with Ultrasound Guidance - Procedure Guide

Thoracentesis - Procedure Guide

Picasa Web works great: it resizes the images automatically to fit the monitor size and pre-fetches them so that the slideshows load faster. Our previous host, Webshots, used to place too many banner ads around the images but I chose it over Flick because it offered a larger resolution of the slideshows.

Andrew Schechtman of MeisterMed contacted me last week with the suggestion to create a free PDA guide for clinical procedures. I hope that this project is completed soon.

Of course, our slideshows cannot compete with the excellent professional NEJM videos but this is not the goal. The idea is to help any health care worker anywhere in the world by offering a quick reference guide to refresh the memory about a certain procedure before performing it. In our informal surveys, many residents at the Cleveland Clinic and Case Western/St. Vincent find the guides very helpful.

Unfortunately, NEJM recently removed their procedures videos from the free area of the website and started to charge $ 10 per video.

Update 06/26/2007:
Picasa Web has a mobile version and map locations.

References:
Procedure Skills and ACLS Refresher
Put your photos on a map, and Picasa on your phone. Official Google Blog, 06/2007.