Inferior Vena Cava

Draw as you push, down

toward the clavicle– NO

NO, STOP. Down! Toward

the clavicle, the boundary there

is hard, the vessel is soft,

the return is bright, pink, rewarding

with a gush. That’s not a subclavian

anything! Ease it in… no, down!

Suck as you advance, draw in until

you reach that sweet gushing pink

moment, there! Now remove the bulb,

keep it stiff! Let the needle sit, no!

That’s the damn Niagra Falls coming

out like a honeymoon: plug it! No!

With the dilator, advance the dilator!

There… softly, tease it apart, no…

that’s fine, that’s just enough blood

as I’d expect for a first time, no need

to worry if you keep the pace, good.

Dilate. Tease it apart, yes, gently,

gently…. Insert the guide wire.

Hold the catheter in your right hand,

hold the guide wire in your right hand,

hold the neck with your wrong hand,

I meant the left, it was a joke. NO!

Hold the catheter! Use the same hand

to draw it in, advance the wire. Keep it

in place, continue advancing the wire…

is it moving? NO. You need to move

in, out, down,

advance the wire. There. Good, now

feel the site, don’t puncture the vessel!

Good… Leave it there, hold the catheter.

With your wrong hand, NO! Keep it sterile!

Reglove. You have botched the whole thing

with the disgusting rotating nurse, remember

that you wouldn’t touch her with a 10-foot pole!

Now… push it in. Good, feel it slide in, right?

That’s how you know it’s good, nice and patent.