Remember what DDK said

I am not a venous sampler

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that being said

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its not as hard as you think

rember that

its not has hard as you think - its realy not

but prior to going in its always like shi****

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Adrenal vein sampling:

use Sim 1 and 2 glidecaths

R and L renal are pretty easy

L adrenal comes off the L 

if you use the big Sim 1 glidecath and push, it will propalse upwards and cannulate it very easiliy- saw it done

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the right adrenal you have to fish- use the mik

AngioD- Mik just like MM

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Fish above R renal and below R accessory Hepatic

you should find it

cortisol tells you you sampled the adrenal

aldosterone tells you which side to remove

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if you rember that your gold

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Parathyroid samplings:
very easy- just stick RCFV and go up the tree trunk

3 spots each IJ

BCV bl

Subclav bl

IVC

not much else to say

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again harder to go in the room then to actually do the case

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--

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adrenal venous sampling take 2

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after doing a few i'm not sure what the big deal is

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its like this

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htn, hypokalemia

presumed hyperaldosternosim

ct findings dont matter

if could be unilat or bilat (the adrenal tumor)

therefore, you need AVS to tlel which side to resect (if at all)

during procedure you get two values

cortisol and aldosterone

cortisol tells you if you actually sampled the adrenal vein

so ithe adrenal sample cortisol must be higher than the peripheral blood

so thats one

then assuming you have R and L samples that are both from the adrenals(the cortisol value is higher than peripheral in both)

then see if the aldosterone values check out

if one side is the adenoma, it should be way higher in aldosterone, like multiples

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to do the procedure

ZB / JM method

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BL groin venous access

6 F sheath

cosyntropin (ACTH ) ready to go, dose i forget

use SIm1 glide cath for L adrenal, hook into L renal and then pull back to hook into L adrenal (usually common trunk with phrenic)

use SIm2 glidecath for R adrenal- sometimes hard to form.  Can use tevdek suture like DK

search for R adrenal by loking right then going R posterior

fish for it

will usually find a accessory hepatic, if so its usu 1 cm below that

make sure you get times on all the samples

make sure you get the list of samples from the RN

duno what else to say

 

More tips: did one with GP 5/12/17

 

Dont ever give up

spent forever trying to get R Adr V

used mik

chung

sos 1

cobra

cobra glide

 

made side holes:  use hole punch and slide wire through cath tip and punch out sidehole

 

use technique of microwire:  advance microwire (GT glide) through cath and then use toughyB to suck blood from sidearm

 

keep looking:  Front, back, left right

eventually something will cath it

 

stare at the stock and decide which catheter will slide into the vein

 

Get a CT V

 

Do a slow infusion while spinning the tube:  get a DynaCt spin and eval

 

do it over and over and it will work- procedural success SG 6/1/2017 Bia***

 

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