18 Sept 2022
26m

TIRBO #18: Mastering dilation

Podcast cover

Critical Care Scenarios

The podcast addresses the nuances of dilation during the Seldinger technique, a critical step in bedside procedures. It emphasizes the importance of ergonomics, advocating for holding the dilator close to the skin in an overhand position and applying firm, steady, patient pressure rather than jerky motions. Dilation occurs when the dilator moves past tissue, requiring a time element and patient application of pressure. The discussion covers managing loose skin by twisting the dilator to take up slack and widening the tract by twisting and withdrawing the dilator in tight tissue. It also highlights the technique of continuously moving the wire during dilation to prevent kinking, ensuring the wire moves freely by adjusting the dilation angle.

Outlines

Part 1: Introduction, Ergonomics

Part 2: Positioning, Angles, Traction

Part 3: Skin Nicks, Twisting Techniques

Part 4: Troubleshooting, Best Practices

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