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Dear First name / Colleague, Earlier this month, we were lucky enough to share our experience in high-risk OB Anesthesiology and Critical Care with nearly one hundred Perinatologists and trainees at the Society of Maternal Fetal Medicine's Annual Meeting. It was an incredibly meaningful experience for us, and hopefully a productive day for those who attended! Check out the highlights! February updates: - Check out Episode 6 of Partum the Interruption, “You Break It, You Buy It: Post Dural Puncture Headaches,” with guest OB Anesthesiologist Dr. Adithya Bhat of Washington University in St Louis! In this final episode of Season One, Dr. Bhat leaves no stone unturned as he discusses the diagnostic criteria for PDPH and the evidence behind all the common treatments.
- Scroll to the end for Partum Pearls, where we share our approach to difficult IV access in parturients.
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We have a busy educational agenda over the next few months and would love to see you at one of our workshops! - Maternal Medicine Workshop, SOAP Annual Meeting: New Orleans, LA
- Diabetes Management in Pregnancy
- Asthma Management in Pregnancy
- Sepsis in Pregnancy
- Anticoagulation in Pregnancy
- Rare Diseases on L&D: Sickle Cell, Myasthenia Gravis & Multiple Sclerosis
- Best Practices in Labor Analgesia: NYSORA CME Retreat: Orlando, FL
- Pain Management on L&D: Neuraxial, Intravenous, Patients with Opioid Use Disorders, Truncal Blocks & Non-Pharmacologic options
- Neuraxial Techniques: CSE vs DPE vs Epidural, Neuraxial Ultrasound, Paramedian Approach, Difficult Epidural Placement
- Working with OB Anesthesia: Updates and Hot Topics, AWHONN Convention: New Orleans, LA
- Homeostasis During Labor: Food & Fluid Management
- When the Block's Not Hot: How to Assess & Advocate For Your Patient
- Emergencies on L&D: Maternal & Fetal Resuscitation
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💉Take Your Best Shot: The Basilic Vein |
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Peripheral IV catheter placement can be challenging in pregnant patients who are obese, edematous, frequently hospitalized, have chronic illnesses, or a history of IV drug use. Antecubital veins, though tempting, are better avoided because they occlude easily as patients move around during labor. Ultrasound-guidance allows us to access deeper targets above the antecubital fossa, such as the basilic vein [1]. The basilic vein is typically the largest vein in the upper arm not accompanied by an artery [2], but because of its medial position, it is often overlooked. Its depth depends on body habitus, but it typically lies 1.2cm (0.4 to 3.5cm) medial to the brachial artery at the antecubital fossa [3], and is easily visualized by ultrasound in the upper two thirds of the arm. The basilic vein is almost always patent, even in those who use IV drugs, and is a reliable target when cannulation of distal veins fails. Ultrasound should always be used to reduce the number of attempts and avoid injury to the median and ulnar nerves that lie in close proximity to the vein as it courses proximally [1]. |
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A 2007 study of 25 patients assessed the utility of ultrasound-guided cannulation of the deep brachial or basilic vein in patients with difficult peripheral access. Median time to initial vein cannulation was 3 minutes. The median duration of access was 26 hours and the only observed complication was early infiltration in 1 subject [4]. In another study with 100 patients (50 of whom were IV drug users and 21 were obese), cannulation was successful in 91 patients and achieved on the first attempt in 73. Observed complications were line infiltration within 1 hour of cannulation in 8 patients, and 2 cases of brachial artery puncture [5]. Both studies demonstrate that ultrasound-guided basilic vein cannulation is safe and has a high rate of success among patients with difficult peripheral IV access. |
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https://proceduralist.org/us-guided-iv/us-iv-technique/ |
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SafePartum Tips: - Call your OB Anesthesiologist early when IV access is difficult.
- Abduct the arm up to 90 degrees and externally rotate it to optimize visualization and position. Scan proximally from just above the AC fossa on the medial (ulnar) side of the upper arm.
- Localize the entry point and tract with a small amount of local anesthetic for patient comfort.
- Use a long IV catheter (18g or larger) rather than standard length. Standard length catheters in deep veins are far more likely to infiltrate due to their limited intravascular course.
- Periodically assess the IV site (use ultrasound when in doubt) for signs of infiltration. Adiposity of the upper arm may conceal subtle signs of fluid or medication extravasation.
- Given the long and proximal location of basilic vein catheters, sterile technique is recommended!
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- N. P. S. Sandhu, D. S. Sidhu, Mid-arm approach to basilic and cephalic vein cannulation using ultrasound guidance, BJA: British Journal of Anaesthesia, Volume 93, Issue 2, August 2004, Pages 292–294, https://doi.org/10.1093/bja/aeh179
- https://proceduralist.org/us-guided-iv/us-iv-technique/
- Mukai K, Nakajima Y, Nakano T et al. Safety of Venipuncture Sites at the Cubital Fossa as Assessed by Ultrasonography. J Patient Saf. 2017;16(1):98-105. doi:10.1097/pts.0000000000000441
- Mills et al. Ultrasonographically guided insertion of a 15-cm catheter into the deep brachial or basilic vein in patients with difficult intravenous access. Ann Emerg Med. 2007 Jul;50(1):68-72. doi: 10.1016/j.annemergmed.2007.02.003.
- Keyes et al. Ultrasound-guided brachial and basilic vein cannulation in emergency department patients with difficult intravenous access. Ann Emerg Med. 1999 Dec;34(6):711-4. doi: 10.1016/s0196-0644(99)70095-8.
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