跟读练习: Femoral access: step-by-step and troubleshooting - Mazen Abu-Fadel, MD - 通过YouTube学习英语口语
C1
Welcome to Cardiovascular Innovations 2020.
119 句
如果句子过短或过长，请点击 Edit 进行调整。
1
Welcome to Cardiovascular Innovations 2020.
2
My name is Mazan Abu-Fadal
3
and I'm an interventional cardiologist at the Oklahoma Heart Hospital North Campus
4
and a clinical professor of medicine at the University of Oklahoma.
5
Today we're going to be discussing femoral access,
6
step by step, and troubleshooting.
7
I have no disclosures related to this talk.
8
Of course, whenever possible, radial first is a good idea.
9
However, femoral access is still needed for a variety of procedures,
10
and knowing how to do good femoral access can save the patient a lot of complications.
11
The ideal puncture site is what we're going to start with.
12
If we can puncture the femoral artery right in the middle of the head of the femur with one anterior stick,
13
the risk of complications is going to be much less than
14
if we puncture the femoral artery above the most inferior border of the inferior epigastric artery,
15
or if we puncture the femoral artery below the most inferior border of the head of the femur.
16
Even though we may still be in the common femoral artery,
17
this can still cause complications because manual pressure is not going to give us good.
18
This is because this area of the common femoral artery above the femoral head
19
is the closest to this bony landmark where compression can cause hemostasis.
20
Access above or below the femoral head is going to increase complication rates.
21
And another important thing we can see from this picture is how the femoral artery,
22
when it transitions to the iliac artery,
23
starts diving down into the pelvis.
24
This is important when we're talking about ultrasound.
25
Now, first, we started using fluoroscopic markers to try and tell us where the femoral head is,
26
where the inferior border is,
27
and to try and start our axis at that point so we don't have low axis and hopefully not high axis.
28
The problem with this approach is even
29
when we put the landmark at the inferior border of the head of the femur
30
and we start our axis at 45 degrees with the needle there,
31
if the patient is very thin and there's not a lot of subcutaneous tissue,
32
we're going to access that artery.
33
On the other hand, if the patient actually has a lot of subcutaneous tissue and is obese,
34
which is most of the patients we see these days,
35
even when we start from the inferior border of the head of the femur,
36
by the time the needle gets into the artery, it's already too high.
37
Ultrasound guided access can help with that quite a bit.
38
Ultrasound guided access can help with the artery and the bifurcation
39
and can also help us detect the needle insertion in the anterior wall of the artery.
40
Doing ultrasound requires some good technique and there's a learning curve.
41
However, after around 15 procedures,
42
you can be good at it.
43
Usually we like to start looking with the ultrasound either at the inferior border
44
or in the middle of the head of the femur
45
and then scan up and down until we see the bifurcation
46
and go above the bifurcation where the common femoral artery is located.
47
The nice thing about the ultrasound is we can also do longitudinal views to see the wire,
48
make sure it's not going sub-intimal
49
or make sure there's not a lot of calcifications or disease in the artery before we even get access.
50
Ideally, we want to get the access above the bifurcation of the femoral artery.
51
So here, even though the sheath is perfect in the middle of the head of the femur,
52
you can see it did go in the bifurcation.
53
The goal is to have an access which is above the bifurcation in the common femoral artery
54
and still below the most inferior border of the head of the,
55
oh, sorry, of the inferior epigastric artery.
56
This can be achieved with ultrasound guidance much better than with a fluoroscopic guidance.
57
In addition, ultrasound guidance will help us decrease the number of attempts.
58
First pass success rate is actually higher,
59
time to sheet insertion is lower,
60
and risk of venipuncture is lower.
61
The use of micropuncture is also very important if used properly.
62
When we get access with micropuncture,
63
we are using it with ultrasound guidance,
64
and we use the micropuncture that had the braided tip so
65
that we can reflect the sound wave and see them on the ultrasound.
66
After access obtained and the wire is advanced and before removing the needle,
67
a quick fluoroscopy at the site of insertion will show you the transition between the needle head and the wire.
68
If this transition is at the level of the middle of the head of the femur,
69
then that's perfect.
70
If it's too high or too low,
71
then you want to repeat the access after you remove the wire and the needle and hold.
72
There's been claims that micropuncture can increase vascular complications and specifically it can increase retroperitoneal bleeding.
73
The micropuncture wire goes into one of the smaller pelvic wires like you see in panel A.
74
This is why it's very important when you get access to look at the needle wire interface,
75
and if it's too high like you see in the first panel,
76
remove, hold pressure, then access again like you see in the middle panel.
77
However, in the middle panel,
78
after we got access and we advanced the wire a little bit,
79
we took a fluoro and it was going in one of the pelvic arteries,
80
which, especially if the wire is hydrophilic,
81
can perforate that pelvic artery and cause bleeding and with anticoagulation retroperitoneal hematoma.
82
This is why looking at the insertion site as well as the direction of the wire,
83
make sure it's going in the iliac arteries up to the aorta.
84
It's going to be very important before we exchange to the micropuncture dilator and wires.
85
After coronary, sorry, after sheet insertion,
86
you want to do femoral ingiography.
87
Femoral ingiography is very important and in my opinion,
88
should be done before the procedure is started and before any anticoagulation is given.
89
You can see from this picture how the sheet is actually touching the wall of the artery,
90
and if injection is being done,
91
this can dissect the artery.
92
This can be prevented from getting a wire through the sheath when taking ephemeral angiogram,
93
which is standard we use all the time now.
94
And this will deflect the tip of the sheath away from any tortuosity in the artery
95
and allow you to inject even using an injector or a syringe without worrying about dissection.
96
So what is the ideal technique for femoral access?
97
Locate the femoral head.
98
Make sure where the lowest point is and where the middle of the head of the femur is.
99
Use ultrasound guidance to use a micropuncture with it and try to access the femoral artery at the correct level.
100
Make sure you scan up and down to see the bifurcation.
101
And when you're scanning up,
102
if you see the femoral artery start to dive down into the tissue further away from the ultrasound,
103
this means you're too high.
104
You're most likely in the iliac arteries.
105
After you put the, after you access with the needle and you advance the wire,
106
take a quick flora, make sure the transition of the tip of the needle
107
and the wire is in the middle of the head of the femur
108
and make sure that the wire is going towards the aorta and not the pelvic arteries.
109
After all that is done,
110
put a wire through the sheath,
111
take a femoral angiogram, and then if needed,
112
you can upsize the sheath for structural interventions or hemodynamic support,
113
or just give anticoagulation for your intervention.
114
The femoral angiogram also helps you make sure the size of the artery is good
115
and there's no disease or complications there that prevent you from using vascular closure devices if
116
Thank you very much for your attention.
117
For any questions or comments,
118
please feel free to email me at this email.
119
I hope you enjoyed this meeting.
下载应用
AI 为你说出的每个句子打分
TRENDING
热门
为什么要通过这个视频练习口语？
通过观看和跟随Mazen Abu-Fadel博士的讲解，学习者能够在真实的医学语境中提高英语口语能力。这个视频不仅提供了关于股动脉穿刺的详细步骤，也贯穿了许多专业术语和表达方式，帮助学习者在医疗对话中建立自信。此外，通过模仿视频中的语速和语调，学习者可以有效地提高英语发音，尤其是专业领域的语言表达能力。使用看YouTube学英语，学习者能够在轻松的环境中反复练习，进而提升自己的沟通技巧。
语法与上下文中的表达
- 被动语态：视频中提到“手动压力不能很好地解决”，这种被动语态的使用，帮助学习者理解复杂的医学过程如何影响患者。
- 条件句：讲解中使用的“如果……，我们就……”，例如“如果患者很瘦，我们会刺入动脉”，有效地传达了在特定情况下的行动计划。
- 专业术语：言辞中频繁出现“股动脉”、“超声引导”等医学术语，丰富了学习者的专业词汇，为日后的学习打下基础。
通过这些表达，学习者不仅能掌握专业语言，还能提高在相关领域内使用英语的流利度，增强交际能力。
常见发音陷阱
在这个视频中，有些词汇可能对学习者构成发音的挑战，例如“femoral”（股动脉）和“bifurcation”（分叉）。这些专业术语的准确发音对交流至关重要，尤其是在医学领域。同时，视频中Mazen医生的口音虽然清晰，但某些医学术语的重音可能与学习者的本土语言不同，因此需特别注意。学习者在跟读时，可以利用影子跟读技巧，反复练习这些词汇，以提高自己的发音准确性和流利度。
同时，通过提高英语发音的实践，学习者可以俾克服不同口音带来的理解障碍，增强在国际场合的交流能力。
什么是跟读法？
跟读法 (Shadowing) 是一种有科学依据的语言学习技巧，最初开发用于专业口译员的培训，并由多语言者Alexander Arguelles博士普及。这个方法简单而强大：您在听英语母语原声的同时立即大声重复——就像是一个延迟1-2秒紧跟说话者的影子。与被动听力或语法练习不同，跟读法强迫您的大脑和口腔肌肉同时处理并模仿真实的讲话模式。研究表明它能显着提高发音准确性，语调，节奏，连读，听力理解和口语流利度——使其成为雅思口语备考和真实英语交流最有效的方法之一。