I think vascaths or swan introducers are useful if you can get them in for faster flow rates (not a central line). But would still use an ultrasound to insert it (as likely to be a little more technically difficult if they are significantly hypovolaemic).

Putting a central line in on ICU as an SHO on a level 2 patient, local had gone in and getting ready to start and the patient shouts ‘I am a snake’ and kind of wriggles off the bed like a snake. We were all so shocked no one stopped him! Luckily I’m short so the bed wasn’t that high 🫣

All based on my assessment of the patient. Theatre patients have pre-filled metaraminol/atropine if needed and run a pressor infusion for those who will definitely need it. ICU patients often have dilute adrenaline (10mg/ml) and metaraminol drawn up.

I work in a DGH that is the Maxfax centre for the region. About once a month I will have a patient on the emergency list with negligible mouth opening, AFOI only option. Imagine very few of us do 20 a year but we are competent at it, not enough people to have a separate rota.

Do your machines already have a hose with a Schrader valve at the wall end? If so can just get a portable cylinder with quick release Schrader valve. This is what we have done, much easier than trying to sort yokes. If they don’t then I’m sorry my solution is useless!

The analogy I use is: imagine drawing up 20mls of propofol into a syringe and squirting 19mls down the sink and only getting to use 1ml for the patient. That is the proportion of nitrous used for patient vs lost to the atmosphere. Portable cylinders massively reduce this loss.

As well as physical leaks and loss from machine testing, when a manifold alarms low pressure the cylinders are all changed and any residual nitrous in the cylinders vented into the atmosphere, sometimes this could be a significant volume of nitrous, which contributes to global warming and ozone loss

Yes! No brainer! In my hospital there is a piped supply to so many areas that haven’t used it for years/decades. Decommission manifolds (a proportion of which just gets vented back to the atmosphere) and switch to using portable cylinders. This also reduces nitrous wastage from machine checks.

The hoses are pretty long, but yes using them is an excellent idea! Will see if I can get that adapter ordered!

Just dug out Wards and realised it is a NIST valve! So need a cylinder with a regulator with integral schrader valve, then a small length of pipe with a quick connect schrader probe on one end and a NIST on the other. Does anyone have this setup and if so can tell me where you got it please!! 😃

Thanks Garry, that is the plan- I’m just wondering what bit of kit people used for this, as it seems for our machines you would need a cylinder ->regulator ->short piece of piping with a screw valve on the end, the name of which I don’t know (have just been calling it a screw style schrader 😂)

I am pleased the ICS have come out with a much needed statement of support rather than yet another ‘helpful to have clarity’ which is neither helpful nor provides clarity.

I have a remarkable and it’s invaluable to me. Used it for FICM revision, now have access to all those notes at all time on my phone. Use it to make notes for conferences and as a way to read and notate papers. Also helpful to entertain the kids if you forget paper for drawing!