What is up YouTube? Welcome back to my channel. For those of you who are new to this channel, my name is Michael aka Dr. Chalini. I am a fifth year interventional radiology resident. Now on today's video, we are going to be doing something a little different. I actually haven't done one of these videos since way back almost a year ago or maybe a little more than a year ago. Today we're doing ununboxing and we are unboxing an arrow, Himadialysis catheter or tumble catheter. It is expired all the way back in 2005. Oh wait, 2008, which it's been sitting in a closet for that long, untouched. We keep these around just for like students and you know educational purposes. So today I figured I would unbox one for you. So let's go. All right. So what do you say we open this thing up? This is going to be loud. So obviously we have the sterile cover. So the tech would open or whoever would open the dialysis catheter and dunk this on the field and I would open it. So let me show you guys what's inside. All right. So this is what it actually looks like. So as you can see we have everything. So we have the catheter up here. We have our guide wire. We have a clip which we don't need. We have our tunneler. We have our sheath and our dilators as well. So let's open this up and see what's inside. So as you can see the catheter actually comes separate. We have to actually put this together and we have to cut right here which I don't have scissors in the pit which they're usually provided with us on the table. So let me walk you guys through this whole situation here. All right. So the first thing we would do is we'd use our ultrasound machine. We take a small needle as you can see right here. Hopefully that's focusing. So this is an 18 gauge needle. We usually access with a 21 gauge micro-puncher and you actually access. I'm not going to do it on myself but you would access the internal cellular vein. Once you gain access with if you use an 18 gauge needle you can directly place this guide wire. I don't know if you can see that. So you ultimately place this guide wire, it's a J wire and you can see as you this is our cheater system. You would put this through the needle and you would thread this down the entire length down to the IVC. So what you would have is basically something like this and this would be kind of hanging out of the neck. There are plenty of videos on here that actually show the whole procedure being done but I'll just describe it to you without actually doing it. So once you have the wire down into the IVC you can then begin to start assembling your catheter. So I'm going to put this over here. This is what the catheter looks like completely assembled. So then you would make your dermatotomy site where you would tunnel your catheter underneath the skin which would be just below the clavicle. You would use this tunneling device to kind of connect the dermatotomy to the vanotomy site so that your catheter has a nice tract underneath the skin. Once you have that done you can start dilating your tract up on your vanotomy site. So again we have our wire and we made our tunnel, we have our wire. We put the dilator on the wire, advanced down, dilate up the tract so you can see this nice big 15 French catheter it can go through. Once we dilate up the tract we'll put in our peel-away sheath over the wire. Peel-away sheath over the wire. Once we have that in place we have our tunnel catheter up kind of hanging next to it. Then what we can do is remove our inner silet of the sheath and the wire itself. What you want to do is put your finger over this because it'll bleed like crazy. As you can see you have a big hole that size in the jugular vein. Put your finger over that. You will then thread the split tip catheter through the peel-away sheath as you can see so it'll be something like this. Once you have it in that sheath you can break apart the sheath. Peel it open like this the catheter stays in place it's kind of hard to do. Peel the sheath off. Now you have the catheter hanging just above or in the right atrium and all of this is underneath the stand and within the chest cavity except for this little hub right here with the two injectable ports hanging out. This entire thing from here over is actually inside the stand or under the stand and this part is what hangs in the right atrium. This part is on the outside. This is what a tunneled hemodialysis catheter looks like. Again only this part is exposed so that you can use this as your means of dialysis. That is obviously an oversimplified direction on how to place a hemodialysis catheter and what a hemodialysis catheter actually looks like. Again there are plenty of YouTube videos out there that kind of walk you through this and show you them doing it in real time. I just cannot film doing this on a patient. Maybe I'll be able to do it eventually just not while I'm in training. So here you go. Hemodialysis catheter. I hope you guys enjoyed it. So on that note that concludes this video. If you like this kind of unboxing and teaching video and a little insight into the supplies that we use in interventional radiology and the devices we use let me know in the comments below or if you want to see a specific device let me know in the comments as well. Otherwise make sure you smash that like and subscribe button do it now. Follow me on Instagram if you don't already otherwise I will see you guys on the next video.