Jas Gill is an accomplished history buff with a flair for emergency medicine. Having recently graduated from residency, she is currently pursuing a fellowship in surgical critical care at University of Maryland, Shock trauma medical center.
She is a resident in the Emergency Medicine/Internal Medicine program at the University of Maryland Medical Center. She’s a researcher in Forensic Psychology and Biomedical Neuroscience, however, her greatest accomplishment is the ability to rap most of Eminem’s repertoire of music. Sharleen is the infographic wizard of CriticalCareNow.
The Pre-brief
When your patient is in hemorragic shock, go BIG or go HOME!
What is it?
Cordis is a brand name for a large lumen cannula that is used for resuscitation in the acute setting. If your trauma patient is in hemorrhagic shock, as the nurses attempt to get large bore access, you should be reaching for a cordis kit. The lumen on a cordis is typically 8-11 French and will have one vascular port that is 16 g. In comparison, a typical triple lumen CVC has 16g/18g/18g ports within a 7 French cannula. Some institutions use a MAC, which has a 9 French cannula and two distal ports for more IV access.
Why do we use a cordis and not a triple lumen?
We know from physics that in a tubular structure (venous cannula) flow rate is proportional to the radius and inversely proportional to the length of tubing. Therefore, the higher the lumen and shorter the length, the better the resuscitation catheter.Â
How Do I Place It?
The basic over the guidewire Seldinger technique is similar to the technique used for central lines. Here are some key differences:
- A cordis can be safely placed in all 3 typical locations used for a CVC. In the crashing trauma patient, you will not have access to the IJ as they will likely be in a c-collar. Depending on the injury, and the ergonomics of the room you may choose to place one in the subclavian or femoral veins.
- The Cordis kit comes with the dilator already preloaded backwards in the catheter. The first step in setting up for the procedure is to remove the dilator and load it through the cannula.Â
- When it comes to making a skin incision consider making it bigger than for a routine CVC as the cannula is wider. Remember, the dilator is already pre-loaded so once you make an incision you don’t have to load and unload the dilator.
- Once an adequate incision is made you should have an easy time inserting the cannula as it tends to be stiffer than a regular CVC.
- In obese patients, get someone to retract the subcutaneous tissue or tape it before hand while making sure that your angle of insertion is low (having confirmed that you’re in the vessel on US). As the cordis cannula is stiffer if your angle is too steep or you are pushing against tissue you will be more likely to bend the wire.
- When you are ready to pull the wire you will grab the wire and the dilator and pull them out together. The cordis has a one way valve so you will not get back bleeding, but make sure you clamp the side port before removing the wire.
- A Cordis or MAC can also be used to introduce a temporary venous pacer or a PA catheter once the acute resuscitation is done. However, be mindful of the cannula size and pacer sheath size that your institution has before you attempt this.
The Debrief
Size does matter when it comes to flow rates in resuscitation with volume.Â
