this is dr greg hickman here at the anders institute uh we're gonna do an interscaling catheter today uh for a young man having some shoulder surgery we're gonna use our clarius to put our catheter in and we'll show you how we do our approach we're going to come in posteriorly and put the probe right over the interscalene uh brachial plexus uh right here in the neck okay we'll go down supraclavicular you can see the artery with the rib right under it the brachial plexus right there about uh 12 to 3 o'clock and then we'll follow that plexus back up the neck until we get our stomp line right here between the two muscles okay oh he's a tough one right there you can kind of see it right there we'll kind of mark our probe so we know where we're coming in then we're going to prep and drape posteriorly here so rocky my block nurse is going to hand me the probe here he's got it right back where we had it marked before now i still got the probe it's easy to hold i'm on the non i'm on the sterile side the probes over there with rocky on the non-sterile side so tough to see you've got some nerves right in there between the you can see the anterior middle scalene muscles better than anything but this is where we want to go all right a numbing shot here on three one two three that uh boy then we're gonna come in with our tui a lot of pressure ah so coming in posterior we got our needle coming in parallel to the face of our probe so you can see the needle right there coming on across the screen from right to left you see the tip pretty bright there we're in the middle scalene muscle we're going to go right through the middle scaling muscle as soon as we pop through that we're gonna start giving some local we should be getting a little shoulder twitch here any second i think i'm in there so i'm gonna give a couple cc's and see what we've got give me a couple right there rocky i think we're in the right space okay go ahead and give me five inspiration yeah where my go there it is there we go so it's opening up that space between the nerves and the middle scalene really well you see it right there now we've opened up that space really well i'm gonna stop right there i'm gonna let rocky take my probe right there and we're getting a little twitch so we got a little closer to the nerves got a twitch now we're going to slide our catheter in this space just to the right of the stoplight perfect see the needle see the catheter come out right there i'm gonna lay the catheter down you're good and then bring the catheter back up threading the catheter just between the brachial plexus interscalene stoplight and the middle scaling muscle then we're going to take the needle out can you see it well on that froggy okay i think that laid in really well i used to do a complete flip with the tip of the catheter now i just lay it down and back up in that space take our guide wire out bring our catheter all the way out we're going to check this catheter with the ultrasound so got a beautiful view right there we're going to test this one two three boom you can see the what lightening up the white little air came through and then the spreading out the space between the three stop lights you see real well right there and the middle scaling muscle which is on the right that's a really nice picture right there and this is he's not the easiest anatomy he's kind of a big guy so it makes a little tough but we're able to do it and now you see a really good picture of the anterior scalene the middle scalene and that three that stoplight sign right in the middle with the c5 and c6
