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We just saw a patient with ARDS 
in prone position who happened to loose his IJ central access. Popliteal fosa is easily accesible in this position so we decided to take a look! 
#POCUS #CVC 1/
in prone position who happened to loose his IJ central access. Popliteal fosa is easily accesible in this position so we decided to take a look! #POCUS #CVC 1/
Distinguishing artery from vein is easy: Vein collapses with pressure
. Doppler can help when in doubt: Loot at arterial vs venous waveforms!
Anatomy is very important!! If you don't pay attention you can skewer the Tibial Nerve! 2/
. Doppler can help when in doubt: Loot at arterial vs venous waveforms!Anatomy is very important!! If you don't pay attention you can skewer the Tibial Nerve! 2/
90 degree rotation 
of the probe reveals long axis. I prefer this axis for vascular access given full view of the needle. However, probe position at the popliteal fossa locates the vein on top of the artery and risks arterial puncture (also watch out for the tibial nerve!) 3/
of the probe reveals long axis. I prefer this axis for vascular access given full view of the needle. However, probe position at the popliteal fossa locates the vein on top of the artery and risks arterial puncture (also watch out for the tibial nerve!) 3/
Structures are to tightly together at the popliteal fosa. But if you displace the probe proximally structures separate nicely! 4/
So...How to cannulate? A recent @JAMA_current article has a nice video. 
However, just because it's published in JAMA does not immediately mean it is a good idea 
. In fact, there is no study to inform us about safety. This is an opinion piece! 5/ https://ja.ma/39PqePw
However, just because it's published in JAMA does not immediately mean it is a good idea . In fact, there is no study to inform us about safety. This is an opinion piece! 5/ https://ja.ma/39PqePw
Popliteal vein is a small vein = Risk of DVT. Also, I don't know who needs to hear this, but this is not a CVC!!! Popliteal Midline? @DrGalenMD
This approach should be studied against #POCUS guided IJ CVC (posterior approach) which is usually easy! https://doi.org/10.5301/jva.5000754 6/
This approach should be studied against #POCUS guided IJ CVC (posterior approach) which is usually easy! https://doi.org/10.5301/jva.5000754 6/
After this, we decided our patient deserved better so we just placed the CVC on the IJ using a posterior ultrasound guided approach 
.
P/F ratio is better and will supinate tomorrow.
END/
. P/F ratio is better and will supinate tomorrow.
END/
