and this system we've got two seral dpes here because then we can actually adjust the size of our field as needed we see the little bleeding of the local anesthetic injection I used M vacin 1% 2 ml in total for the block of the supraclavicular nerves and the local anesthetic for the inter scaling catheter I use 10 mL of 75 Ry vacum and the total injection volume will be something between 6 and 8 Mill this catheter uh system I will fill it now and the uh it is a system that is with like uh comparable to an intravenous cand uh which I have here and the needle is inside this Cula and so once the needle is in the right position I inject like the main dosage and then I remove the needle um the canula stays in and I insert the uh the catheter inside this canula and uh then I fix it because it can't be inserted as um as deep as anyone wants it has a fixed position and that is quite good because uh several openings of this catheter will end end up exactly in the position where the needle tip was before it has got a blind end of 15 mm in order to have a better catheter fixation in the tissue a little bit of liquid here and now I take the syringe in my hand first so I can actually aspirate and inject with my thumb Put the Needle between my uh fingers here and make sure that the bevel is directed upwards towards the prob and I do like the insertion in the skin without I sound because it is um far up and exactly where I had the local anesthetic through the skin and then I use the same tunnel to go down here and now I start with the ultrasound the marker is directed to my own left eye so it should be a good image orientation now increase gain increase gain now I'm quite happy with the image I go for the uh Superior trunk which is right here and as you see the artery um is um is quite deep so I I'm not really worried about this but I go slightly higher that it's not going to be in my needle trajectory now I insert the needle very very superficial now it comes to the um The Superficial cervical fure I make it steeper to penetrate it with a little click okay and now I inject it right here there it is so the spread of the local anesthetic is posterior to the superior trunk and I've got like um 5 ml right now I put the probe aside normally I would have started a screen a a um a video however it's on the screen video anyway so I take the needle the canula stays in I connect the syringe to the filter of the catheter and the only thing that really needs to be steer out in this system is this little part and I put it in in a no touch technique and it's like a screw so now it is in and I can't put it in any any deeper and now as uh as always I do a catheter position control phase now we've got the image again and this is the position I had before capture video the video is running you see the artery down there slightly higher and now I inject and you see the spread is exactly where it should be and now I've got in total 7 milliliters capture video will stop the recording and now the only thing that needs to be done is catheter fixation and general anesthesia and that's it and now as a matter of Interest we will'll just take another look on the on the diaphragm and see what it does here it is little more again little bit more depth okay capture video my teeth andman on out adman on an admin okay Okay so we've got a dirty curtain so at the moment the diaphragm is functioning perfectly well capture video will stop the recording so at the moment there is a perfect diaphragmatic function after injection of a volume of 7 mL of Ry vacin 0.75%
