> The first beauty of the BIG is the speed. For the first few
> times when we tried out the BIG, myself and one of the other
> regs went head to head with one of us using the BIG, the
> other using a long 14g secalon-t or Wallace IJ cannula
> placing it in the sub-clavian. When the BIG worked it was far
> superior in terms of time to drug administration. The BIG was
> often in before the cannula was out of the packet. There are
> times when you just cant get the femoral or subclavian in.
> Well, in my practice anyway!
Not always a great idea to go for a subclavian (or jugular) line in the
hypovolaemic patient. Femorals can be tricky in the hypovolaemic patient at
times. Couple of ways you can deal with this: long saphenous cut down at the
groin is easy to learn, fast in practice and doesn't fail often (but in the
conscious patient, you'll need a fair amount of LA for the incision). Blind
line insertion is easier with ultrasound guidance. And if you train your
staff in calling for help early, by the time a patient is prepped for a
central line, you can have the consultant in (if your consultants live
reasonably close to the department). Trick is to get people to recognise
their own limitations early and call for help rather than looking for ways
to fudge their limitations. However, at any grade, the more techniques you
have at your disposal, the better, so I'm not suggesting that a consultant
won't elect to use the IO needle.
> The other big advantage is that you can train anyone to use
> the BIG and there usefulness may be in units where there are
> no middle grade cover at night.
Other thing to consider is why you are needing to give fluids so fast in the
first place. If it's trauma, you should have an anaesthetic registrar or
above there in any case. If it's medical you can usually wait until the
consultant gets there (provided the call is made before rather than after it
goes totally pear shaped).
Matt Dunn
Warwick
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