good morning my name is Dr iot we're performing an intercine block with a catheter in a patient who's going to stay awake during the surgery so I will also block the supraclavicular nerves with the local anesthetic which I will use at the same time for the catheter so I do prescan the probe is connected to the iPad with the Wi-Fi and we can see the supraclavicular plexus here and now I can up Wards ah I see a wonderful artery here and I scan further upwards I see the superior trunk right here this will be my target fracture later on and I see that the the vertebral arteries are right here and I can see that C6 is now coming into the transverse process C5 is here right now and C4 is here in the Bony Shadow and I now follow C4 just slightly into what we call the cervical nerves pathway take a little bit of a spray again and put the local anesthetic in capture video this will start the video skip incline Peaks and I will now Put the Needle into this cervical nerve pathway and block the suac clavicular nerves first and then also use the same injection for like subcutaneous tunneling towards my target structure now I proceed with preparation for like the sterile field this is all part of the preparation so I will flush the the filter and the catheter it's a system where we insert a kind of IV line and the needle is inside this canula will be removed later on and the catheter will be put into this canula and will be screwed and so uh it is actually not possible to insert this catheter like uh um to whatever deepness um you feel like so it is a fixed depth um of the um of the catheter inside the canula so the openings of the catheter will be exactly in the position where the needle tip has been before now I take the seing first needle second I will use a uh self injection technique here and I will now Put the Needle in so skip of my inclin paks exactly where the local anesthetic was before freeze increase gain Superior trunk is in the center of the image now I will forward the needle subcutaneously now decrease gain I see some movement of the needle right here and inject here posterior to the superior trunk that is fine 5 minutes capture video capture video I remove the needle take the catheter and the only thing that needs to stay serile is basically this catheter tip I inserted in a no touch technique and fix it with a screw with a lock and make a catheter position control freeze this is the superior trunk again wonderful artery medial to it and get the spread right posterior to the superior trunk right now capture video capture video excellent good position I will fix the catheter now and we're done
