Software: Procedures- Subclavian Line Manufacturer: Meister Med Cost: $2.99 Availability:iTunes App Store
I come at this software as a first year resident, one who has just gotten a handle on central lines in the form of intravenous jugular (IJ) catheterization during my month’s rotation in the ICU. The next step? Subclavian lines. Now, how better do I feel to have a virtual cheat-sheet in my pocket? Much!
In addition to their iSilo catalog, Meister Med offers four iPhone applications: PediDoser, ICD-Meister, the recently reviewed Procedures - Lumbar Puncture, and now, a very simple and straightforward app for mastering these technically challenging central lines. Procedures - Subclavian Line is a standalone multimedia application containing almost everything you need in order to perform a subclavian venous catheter insertion.
First, I explored the Procedure Details section, in which there were Indications, Contraindications (absolute and relative), Complications, Step-by-Step Technique, a Landmarks photo, and (ICD-9) Coding.
I have worked with many different Intensivist attendings, and each has their own reasons for preferring jugular or subclavian lines; though the reality is that different circumstances require different approaches,when there are no other deciding factors, the nature of complications is often considered. Generally, those who prefer to stay away from subclavian lines often site the fear of a pneumothorax as the reason, and those who prefer the subclavian argue that the low infection rate makes it a better choice.
So, the utility of the Complications section of this software is particularly evident. It quotes rates of infection, pneumothorax, hemothorax, catheter malposition, and other complications that may result during insertion of this type of line.
While academic discussions and choosing to employ the subclavian line correctly in the clinical setting are important, your money’s worth is really in the Step-by-Step and video section. Reviewing the text and then opening the standalone video, I feel confident that anyone could skip the “see one” stage of learning. I’m not going to undertake a subclavian line without clinical supervision, but this is a good start and will surely save me from major faux pas. If I could add anything, it would be more in depth landmarking discussion, perhaps including ultrasound-guided techniques.
My apprehension with subclavian lines is related to finding the vessel; I want to be able to get it in as few tries as possible, and not cause a pneumothorax or go arterial in the process. This software hasn’t completely relieved my fears, but it does offer a good starting place.
For less that $3, you can develop a solid approach or hone your technique to this important clinical procedure. It’s well worth it.