Ultrasound-guidance improves success for difficult intravenous access (DIVA), particularly when difficulty is anticipated. However, insertion of a wide-bore sheath, such as a rapid infusion catheter, is likely to pose additional problems and unique challenges in this context, despite ultrasound guidance. With the aid of a video clinical simulation, this article describes an ultrasound-guided technique for inserting a proprietary rapid infusion catheter (RIC) or similar wide-bore sheath using the micropuncture kit.

Airway obstruction requiring emergency airway rescue is an uncommon yet potentially fatal complication following anterior cervical discectomy and fusion. This report describes rapid clinical deterioration after anterior cervical discectomy and fusion despite haematoma evacuation. After failing to secure the airway with awake bronchoscope-guided tracheal intubation and video-laryngoscopy, an I-gel™ supraglottic airway was inserted, and alveolar oxygenation was restored. Bronchoscope-guided intubation was easily achieved via the I-gel™ lumen. The practicality of this technique for airway rescue in the context of a high-stakes time-critical airway emergency is discussed.

Difficult intravenous access (DIVA) is common, with imperfect solutions. Cognitive aids are widespread in anaesthesia; however, a standard DIVA cognitive aid is lacking. This article describes a cognitive aid for DIVA. It has been developed using evidence-based techniques for DIVA. The effects of heuristics, biases, and automatic thinking on procedural decision-making are briefly discussed. While often useful, shortcut decision-making can impair the performance of apparently simple tasks. Cognitive aids may lead to better outcomes by providing choice architecture. This resource is intended as a cognitive aid prototype for difficult peripheral venous access, incorporating both modern behavioural psychology principles and evidence-based medicine. It may be used as both an educational tool, or as a cognitive aid to assist in situations where DIVA is encountered or expected. The adult DIVA cognitive aid is intended for use in both elective and emergency scenarios by practitioners adequately trained in ultrasound-guided or ultrasound-assisted vascular access and Seldinger-based techniques. Clinical implementation and audit of the adult DIVA cognitive aid, or similar locally developed cognitive aids based on this prototype are recommended.