202 timestamped statements
across 13 topics
— auto-found in recorded discussions, each timestamp jumps to the exact moment.
Summaries Mark gave as host are listed separately below.
I actually just put it, make a needle hole with the needle that comes in the kit in the vein, and then I have the catheter already tunneled and trimmed. And I will slide the catheter into that needle hole so that you don't ligate the vein. I don't tie it off.
If it's gram positive, we will, you know, do ethanol lock. We'll treat with antibiotics through the catheter and try to clear the catheter. If it's gram negatives or yeast, the chances of clearing it are much less.
I think that if you get too aggressive with that, you can burn the ileoinguinal nerve and possibly cause inguinodynia, and like you said, I think burnia hurts. It's not pain-free.
really in the micro preemie, if you're talking about a 1000 g baby or even even up to maybe a 2 kg baby, I tend to use three French soft silastic catheter
For gram-positive line infections, ethanol lock plus antibiotics through the catheter can clear the infection; for gram-negative infections, success rate is approximately 50%; for fungal infections (Candida), the line must be removed.
clinicalIf chest X-ray is negative for prenatally diagnosed lung lesion, some practitioners still obtain CT scan at 3 months while others follow with serial chest X-rays↗
▶Ep 22 · 6:52
clinicalIf chest X-ray is negative for prenatally diagnosed lung lesion, some practitioners still obtain CT scan at 3 months while others follow with serial chest X-rays↗
▶Ep 22 · 8:09
quoteWe're not gonna change this. We're not gonna change this. Keep going.↗
▶Ep 22 · 8:09
quoteWe're not gonna change this. We're not gonna change this. Keep going.↗
▶Ep 22 · 8:26
clinicalThree months is considered the optimal timing for congenital lung lesion resection; operating later results in more inflammation and increased difficulty↗
▶Ep 22 · 8:26
clinicalThree months is considered the optimal timing for congenital lung lesion resection; operating later results in more inflammation and increased difficulty↗
▶Ep 22 · 10:08
quoteI think you ought to get a CT at 3 months and act on it accordingly.↗
▶Ep 22 · 10:08
quoteI think you ought to get a CT at 3 months and act on it accordingly.↗
▶Ep 22 · 13:17
clinicalFor thoracoscopic lobectomy, surgeons should be proficient with all vessel control methods: clips, ties, energy devices, and staplers↗
▶Ep 22 · 13:17
clinicalFor thoracoscopic lobectomy, surgeons should be proficient with all vessel control methods: clips, ties, energy devices, and staplers↗
▶Ep 22 · 13:22
clinicalEnergy devices work well for vessel control in small babies and can be used in bigger children with larger energy devices↗
▶Ep 22 · 13:22
clinicalEnergy devices work well for vessel control in small babies and can be used in bigger children with larger energy devices↗
▶Ep 22 · 14:06
clinicalStaplers can fail during lobectomy and are not perfect; surgeons must be prepared for this complication↗
▶Ep 22 · 14:06
clinicalStaplers can fail during lobectomy and are not perfect; surgeons must be prepared for this complication↗
▶Ep 22 · 15:24
quoteIt's always good to have that ready, you know, unfortunately, I'm, uh, I, I, my knowledge is all from experience.↗
▶Ep 22 · 15:24
quoteIt's always good to have that ready, you know, unfortunately, I'm, uh, I, I, my knowledge is all from experience.↗
▶Ep 22 · 18:14
clinicalBefore firing any vessel control device, think through the next two steps if the device fails↗
▶Ep 22 · 18:14
clinicalBefore firing any vessel control device, think through the next two steps if the device fails↗
▶Ep 22 · 24:38
clinicalParaesophageal hernia repair after prior fundoplication requires maximal esophageal mobilization↗
▶Ep 22 · 24:38
clinicalParaesophageal hernia repair after prior fundoplication requires maximal esophageal mobilization↗
▶Ep 22 · 26:52
clinicalBiologic mesh is preferred over non-absorbable mesh in pediatric hiatal hernia repair because non-absorbable mesh erodes into esophageal lumen↗
▶Ep 22 · 26:52
clinicalBiologic mesh is preferred over non-absorbable mesh in pediatric hiatal hernia repair because non-absorbable mesh erodes into esophageal lumen↗
▶Ep 22 · 29:41
clinicalHorseshoe mesh configuration from underneath, wide on good tissue on either side below, addresses the posterior recurrence site↗
▶Ep 22 · 29:41
clinicalHorseshoe mesh configuration from underneath, wide on good tissue on either side below, addresses the posterior recurrence site↗
▶Ep 22 · 33:00
clinicalIf temporizing with feeding tube for post-fundoplication dysphagia, wait 4-6 weeks for swelling to resolve, as this is when inflammation truly decreases↗
▶Ep 22 · 33:00
clinicalIf temporizing with feeding tube for post-fundoplication dysphagia, wait 4-6 weeks for swelling to resolve, as this is when inflammation truly decreases↗
▶Ep 22 · 33:10
clinicalDilation within two weeks of fundoplication risks disrupting the wrap and causing recurrent reflux↗
▶Ep 22 · 33:10
clinicalDilation within two weeks of fundoplication risks disrupting the wrap and causing recurrent reflux↗
▶Ep 22 · 33:54
clinicalAfter Nissen fundoplication, swelling typically resolves and swallowing normalizes around day 18 based on personal experience↗
▶Ep 22 · 33:54
clinicalAfter Nissen fundoplication, swelling typically resolves and swallowing normalizes around day 18 based on personal experience↗
▶Ep 22 · 39:33
clinicalIf operating soon after initial fundoplication, may be able to release obstructing structure without taking down entire wrap; if a year or more out, likely scarred and requires complete redo↗
▶Ep 22 · 39:33
clinicalIf operating soon after initial fundoplication, may be able to release obstructing structure without taking down entire wrap; if a year or more out, likely scarred and requires complete redo↗
▶Ep 22 · 41:07
clinicalBougie size for fundoplication should be based on patient age and weight using published charts; anesthesiologist must pass bougie carefully watching for hang-up at GE junction↗
▶Ep 22 · 41:07
clinicalBougie size for fundoplication should be based on patient age and weight using published charts; anesthesiologist must pass bougie carefully watching for hang-up at GE junction↗
▶Ep 22 · 46:01
clinicalGastric disconnect performed as initial operation or after one failed fundo results in smooth recovery; after multiple fundos, recovery is prolonged↗
▶Ep 22 · 46:01
clinicalGastric disconnect performed as initial operation or after one failed fundo results in smooth recovery; after multiple fundos, recovery is prolonged↗
▶Ep 22 · 46:14
clinicalGastric disconnect can be performed thoracoscopically↗
▶Ep 22 · 46:14
clinicalGastric disconnect can be performed thoracoscopically↗
clinicalIf chest X-ray is negative for prenatally diagnosed lung lesion, some practitioners still obtain CT scan at 3 months while others follow with serial chest X-rays↗
▶Ep 19 · 8:09
quoteWe're not gonna change this. We're not gonna change this. Keep going.↗
▶Ep 19 · 8:26
clinicalThree months is considered the optimal timing for congenital lung lesion resection; operating later results in more inflammation and increased difficulty↗
▶Ep 19 · 10:08
quoteI think you ought to get a CT at 3 months and act on it accordingly.↗
▶Ep 19 · 13:17
clinicalFor thoracoscopic lobectomy, surgeons should be proficient with all vessel control methods: clips, ties, energy devices, and staplers↗
▶Ep 19 · 13:22
clinicalEnergy devices work well for vessel control in small babies and can be used in bigger children with larger energy devices↗
▶Ep 19 · 14:06
clinicalStaplers can fail during lobectomy and are not perfect; surgeons must be prepared for this complication↗
▶Ep 19 · 15:24
quoteIt's always good to have that ready, you know, unfortunately, I'm, uh, I, I, my knowledge is all from experience.↗
▶Ep 19 · 18:14
clinicalBefore firing any vessel control device, think through the next two steps if the device fails↗
▶Ep 19 · 24:38
clinicalParaesophageal hernia repair after prior fundoplication requires maximal esophageal mobilization↗
▶Ep 19 · 26:52
clinicalBiologic mesh is preferred over non-absorbable mesh in pediatric hiatal hernia repair because non-absorbable mesh erodes into esophageal lumen↗
▶Ep 19 · 29:41
clinicalHorseshoe mesh configuration from underneath, wide on good tissue on either side below, addresses the posterior recurrence site↗
▶Ep 19 · 33:00
clinicalIf temporizing with feeding tube for post-fundoplication dysphagia, wait 4-6 weeks for swelling to resolve, as this is when inflammation truly decreases↗
▶Ep 19 · 33:10
clinicalDilation within two weeks of fundoplication risks disrupting the wrap and causing recurrent reflux↗
▶Ep 19 · 33:54
clinicalAfter Nissen fundoplication, swelling typically resolves and swallowing normalizes around day 18 based on personal experience↗
▶Ep 19 · 39:33
clinicalIf operating soon after initial fundoplication, may be able to release obstructing structure without taking down entire wrap; if a year or more out, likely scarred and requires complete redo↗
▶Ep 19 · 41:07
clinicalBougie size for fundoplication should be based on patient age and weight using published charts; anesthesiologist must pass bougie carefully watching for hang-up at GE junction↗
▶Ep 19 · 46:01
clinicalGastric disconnect performed as initial operation or after one failed fundo results in smooth recovery; after multiple fundos, recovery is prolonged↗
▶Ep 19 · 46:14
clinicalGastric disconnect can be performed thoracoscopically↗
clinicalIf chest X-ray is negative for prenatally diagnosed lung lesion, some practitioners still obtain CT scan at 3 months while others follow with serial chest X-rays↗
▶Ep 19 · 8:09
quoteWe're not gonna change this. We're not gonna change this. Keep going.↗
▶Ep 19 · 8:26
clinicalThree months is considered the optimal timing for congenital lung lesion resection; operating later results in more inflammation and increased difficulty↗
▶Ep 19 · 10:08
quoteI think you ought to get a CT at 3 months and act on it accordingly.↗
▶Ep 19 · 13:17
clinicalFor thoracoscopic lobectomy, surgeons should be proficient with all vessel control methods: clips, ties, energy devices, and staplers↗
▶Ep 19 · 13:22
clinicalEnergy devices work well for vessel control in small babies and can be used in bigger children with larger energy devices↗
▶Ep 19 · 14:06
clinicalStaplers can fail during lobectomy and are not perfect; surgeons must be prepared for this complication↗
▶Ep 19 · 15:24
quoteIt's always good to have that ready, you know, unfortunately, I'm, uh, I, I, my knowledge is all from experience.↗
▶Ep 19 · 18:14
clinicalBefore firing any vessel control device, think through the next two steps if the device fails↗
▶Ep 19 · 24:38
clinicalParaesophageal hernia repair after prior fundoplication requires maximal esophageal mobilization↗
▶Ep 19 · 26:52
clinicalBiologic mesh is preferred over non-absorbable mesh in pediatric hiatal hernia repair because non-absorbable mesh erodes into esophageal lumen↗
▶Ep 19 · 29:41
clinicalHorseshoe mesh configuration from underneath, wide on good tissue on either side below, addresses the posterior recurrence site↗
▶Ep 19 · 33:00
clinicalIf temporizing with feeding tube for post-fundoplication dysphagia, wait 4-6 weeks for swelling to resolve, as this is when inflammation truly decreases↗
▶Ep 19 · 33:10
clinicalDilation within two weeks of fundoplication risks disrupting the wrap and causing recurrent reflux↗
▶Ep 19 · 33:54
clinicalAfter Nissen fundoplication, swelling typically resolves and swallowing normalizes around day 18 based on personal experience↗
▶Ep 19 · 39:33
clinicalIf operating soon after initial fundoplication, may be able to release obstructing structure without taking down entire wrap; if a year or more out, likely scarred and requires complete redo↗
▶Ep 19 · 41:07
clinicalBougie size for fundoplication should be based on patient age and weight using published charts; anesthesiologist must pass bougie carefully watching for hang-up at GE junction↗
▶Ep 19 · 46:01
clinicalGastric disconnect performed as initial operation or after one failed fundo results in smooth recovery; after multiple fundos, recovery is prolonged↗
▶Ep 19 · 46:14
clinicalGastric disconnect can be performed thoracoscopically↗
quoteIt's hard to believe that the appendix doesn't scar uh somewhat due the inflammation, which may predispose it to developing an obstruction and acute appendicitis later.↗
▶Ep 4 · 24:39
quoteI think the parents are more focused on the here and now, that is what's happening at that moment in the emergency room, whereas we as their caregivers need to be thinking about what's best for the total life of the patient↗
Pediatric Vascular Access
▶Ep 5 · 1:30
quotereally in the micro preemie, if you're talking about a 1000 g baby or even even up to maybe a 2 kg baby, I tend to use three French soft silastic catheter↗
▶Ep 5 · 1:30
clinicalIn micro-preemies (1000g to 2kg), a 3-French soft silastic catheter is preferred because larger catheters as big as the vessel can cause vessel thrombosis.↗
▶Ep 5 · 2:33
quoteI actually just put it, make a needle hole with the needle that comes in the kit in the vein, and then I have the catheter already tunneled and trimmed. And I will slide the catheter into that needle hole so that you don't ligate the vein. I don't tie it off.↗
▶Ep 5 · 2:33
clinicalNeedle-hole venotomy technique: isolate the internal jugular vein, make a needle hole with the kit needle, and slide the pre-tunneled catheter into that hole without ligating the vein, preserving it for future access.↗
▶Ep 5 · 3:23
clinicalBeveling the catheter end is associated with slightly more catheter thrombosis than cutting straight across, but may be worth it to preserve the vein in micro-preemies.↗
▶Ep 5 · 13:36
guidelineSubcutaneous ports (port-a-cath, meta-port) are used for most intermittent chemotherapy; cuffed lines (Broviac) are used for highly toxic agents like Adriamycin that cause tissue necrosis if infiltrated.↗
▶Ep 5 · 14:32
clinicalBone marrow transplant patients often require three lumens: a double-lumen perm-cath plus a single-lumen line.↗
▶Ep 5 · 14:57
clinicalThe smallest mini-port available is 5-French and can be placed in a 7-8 kg infant, though it requires special order.↗
▶Ep 5 · 15:34
guidelineMRV is the gold standard for pre-operative vascular imaging in patients with multiple prior lines or history of DVT.↗
▶Ep 5 · 17:53
clinicalA glide wire can sometimes pass through venous thrombosis when a standard wire cannot, finding a channel through the clot.↗
▶Ep 5 · 17:53
quoteI took a glide wire and you can take the actually, you know, I said I did a subclavian stick. I actually did an IJ with ultrasound guidance on the right side is what I did, but I used a glide wire. Then I was able to pass the glide wire through the clot.↗
▶Ep 5 · 22:03
clinicalFemoral lines in babies often result in leg swelling and DVT, so they are avoided in that population.↗
▶Ep 5 · 24:40
guidelineInstitutional heparin lock protocol: 10 units/mL for accessed lines (ports or cuffed lines), 100 units/mL for buried ports, and 1000 units/mL for dialysis catheters (which is withdrawn before use).↗
▶Ep 5 · 26:16
guidelineFor gram-positive line infections, ethanol lock plus antibiotics through the catheter can clear the infection; for gram-negative infections, success rate is approximately 50%; for fungal infections (Candida), the line must be removed.↗
▶Ep 5 · 26:16
quoteIf it's gram positive, we will, you know, do ethanol lock. We'll treat with antibiotics through the catheter and try to clear the catheter. If it's gram negatives or yeast, the chances of clearing it are much less.↗
▶Ep 5 · 27:41
epidemiologicalAntibiotic-coated and heparin-coated temporary catheters have been shown to decrease catheter-associated bloodstream infection rates.↗
▶Ep 5 · 28:26
quotewe took a needle through the neck along the thrombosed IJ into the superior vena cava and basically advanced the needle until we got blood back and really at the where the azygous vein comes into the superior vena cava the SVC almost always recantalizes↗
▶Ep 5 · 28:26
clinicalThoracoscopic-guided trans-mediastinal puncture technique: advance a needle through the thrombosed IJ track into the superior vena cava under thoracoscopic visualization; the SVC almost always recanalizes where the azygous vein enters.↗
▶Ep 5 · 29:53
clinicalFor thoracoscopic salvage access in larger patients (17-year-old mentioned), the standard kit needle may not be long enough and an extra-long spinal needle is required.↗
▶Ep 5 · 31:17
opinionThere is speculation (without definitive evidence) that betadine exposure causes silicone catheter deterioration, making old lines chalky and difficult to remove.↗
▶Ep 5 · 32:46
clinicalBroviac cuffs placed far from the exit site are designed to break away with slow, steady traction, allowing bedside removal without cuff excision.↗
▶Ep 5 · 33:14
clinicalIn 17-18 years of practice, only one retained cuff developed infection requiring incision and drainage.↗
Mark's statements about Esophageal Atresia21 statements
clinicalIf chest X-ray is negative for prenatally diagnosed lung lesion, some practitioners still obtain CT scan at 3 months while others follow with serial chest X-rays↗
▶Ep 2 · 8:09
quoteWe're not gonna change this. We're not gonna change this. Keep going.↗
▶Ep 2 · 8:26
clinicalThree months is considered the optimal timing for congenital lung lesion resection; operating later results in more inflammation and increased difficulty↗
▶Ep 2 · 10:08
quoteI think you ought to get a CT at 3 months and act on it accordingly.↗
▶Ep 2 · 13:17
clinicalFor thoracoscopic lobectomy, surgeons should be proficient with all vessel control methods: clips, ties, energy devices, and staplers↗
▶Ep 2 · 13:22
clinicalEnergy devices work well for vessel control in small babies and can be used in bigger children with larger energy devices↗
▶Ep 2 · 14:06
clinicalStaplers can fail during lobectomy and are not perfect; surgeons must be prepared for this complication↗
▶Ep 2 · 15:24
quoteIt's always good to have that ready, you know, unfortunately, I'm, uh, I, I, my knowledge is all from experience.↗
▶Ep 2 · 18:14
clinicalBefore firing any vessel control device, think through the next two steps if the device fails↗
▶Ep 2 · 24:38
clinicalParaesophageal hernia repair after prior fundoplication requires maximal esophageal mobilization↗
▶Ep 2 · 26:52
clinicalBiologic mesh is preferred over non-absorbable mesh in pediatric hiatal hernia repair because non-absorbable mesh erodes into esophageal lumen↗
▶Ep 2 · 29:41
clinicalHorseshoe mesh configuration from underneath, wide on good tissue on either side below, addresses the posterior recurrence site↗
▶Ep 2 · 33:00
clinicalIf temporizing with feeding tube for post-fundoplication dysphagia, wait 4-6 weeks for swelling to resolve, as this is when inflammation truly decreases↗
▶Ep 2 · 33:10
clinicalDilation within two weeks of fundoplication risks disrupting the wrap and causing recurrent reflux↗
▶Ep 2 · 33:54
clinicalAfter Nissen fundoplication, swelling typically resolves and swallowing normalizes around day 18 based on personal experience↗
▶Ep 2 · 39:33
clinicalIf operating soon after initial fundoplication, may be able to release obstructing structure without taking down entire wrap; if a year or more out, likely scarred and requires complete redo↗
▶Ep 2 · 41:07
clinicalBougie size for fundoplication should be based on patient age and weight using published charts; anesthesiologist must pass bougie carefully watching for hang-up at GE junction↗
▶Ep 2 · 46:01
clinicalGastric disconnect performed as initial operation or after one failed fundo results in smooth recovery; after multiple fundos, recovery is prolonged↗
▶Ep 2 · 46:14
clinicalGastric disconnect can be performed thoracoscopically↗
quoteIt's hard to believe that the appendix doesn't scar uh somewhat due the inflammation, which may predispose it to developing an obstruction and acute appendicitis later.↗
▶Ep 3 · 24:39
quoteI think the parents are more focused on the here and now, that is what's happening at that moment in the emergency room, whereas we as their caregivers need to be thinking about what's best for the total life of the patient↗
Mark's statements about Incarcerated Hernia4 statements
quoteI think that if you get too aggressive with that, you can burn the ileoinguinal nerve and possibly cause inguinodynia, and like you said, I think burnia hurts. It's not pain-free.↗
▶Ep 3 · 2:10:20
clinicalIlioinguinal nerve block can be performed under laparoscopic visualization by injecting just lateral to the internal ring defect↗
▶Ep 3 · 2:17:52
clinicalThe external oblique aponeurosis provides no structural support to the inguinal floor↗
▶Ep 3 · 2:18:20
clinicalIn premature infants, the internal and external rings almost overlap, allowing hernia repair without opening the external oblique aponeurosis↗
Guillermo Ares, MD and Mark Wulkan, MD - 2024 Pediatric Bariatric Surgery Update Course
▶Ep 19 · 7:38
quoteyou're telling me that the robot's almost as good as, uh, laparoscopic surgery. Is that what you're saying?↗
▶Ep 19 · 12:00
opinionRobotic technology is still in its infancy.↗
▶Ep 19 · 12:20
clinicalThere has been one robotic vendor for the last 20 years; now there will be at least 2 other robots coming on the market this year, which should create competition and improve instruments.↗
▶Ep 19 · 12:30
quoteI don't know what a robot can add that I can't do↗
▶Ep 19 · 12:50
clinicalLaparoscopic sleeve gastrectomy can be performed with a medical student assistant without taking excessive time.↗
▶Ep 19 · 13:10
quoteall you did, Guillermo, is tell me that you showed, there's, you showed me that the robot is almost as good as straight laparoscopic, only it's more expensive and takes longer.↗
▶Ep 19 · 13:10
opinionUntil the cost of the robot decreases, it will not be widely adopted.↗
Mark's statements about Pediatric Obesity7 statements
clinicalDr. Mark Wolco is the surgeon-in-chief at Children's Healthcare of Atlanta and part of the Strong for Life program as the bariatric surgeon.↗
▶Ep 1 · 0:00
clinicalThis is the fifth year of the pediatric obesity global cast hosted by Children's Healthcare of Atlanta.↗
▶Ep 1 · 0:00
quoteGood morning, good afternoon, and good evening. Welcome to the latest evidence and trends in pediatric obesity.↗
▶Ep 1 · 0:40
quoteThis is the 5th year we've been doing this pediatric obesity global cast, and I think it's gonna be our best one yet.↗
▶Ep 1 · 0:50
clinicalDr. Stephanie Walsh is an associate professor of surgery and pediatrics and the medical director of wellness in the Strong for Life clinic at Children's Healthcare of Atlanta.↗
▶Ep 1 · 1:40
clinicalDr. Chris Bowling is a private practice pediatrician in Kentucky and the chair of the section on obesity of the American Academy of Pediatrics.↗
▶Ep 1 · 2:20
quoteIf you get a blank screen, don't panic, we'll get it fixed.↗
Mark's statements about Pediatric Obesity7 statements
clinicalDr. Mark Wolco is the surgeon-in-chief at Children's Healthcare of Atlanta and part of the Strong for Life program as the bariatric surgeon.↗
▶Ep 1 · 0:00
clinicalThis is the fifth year of the pediatric obesity global cast hosted by Children's Healthcare of Atlanta.↗
▶Ep 1 · 0:00
quoteGood morning, good afternoon, and good evening. Welcome to the latest evidence and trends in pediatric obesity.↗
▶Ep 1 · 0:40
quoteThis is the 5th year we've been doing this pediatric obesity global cast, and I think it's gonna be our best one yet.↗
▶Ep 1 · 0:50
clinicalDr. Stephanie Walsh is an associate professor of surgery and pediatrics and the medical director of wellness in the Strong for Life clinic at Children's Healthcare of Atlanta.↗
▶Ep 1 · 1:40
clinicalDr. Chris Bowling is a private practice pediatrician in Kentucky and the chair of the section on obesity of the American Academy of Pediatrics.↗
▶Ep 1 · 2:20
quoteIf you get a blank screen, don't panic, we'll get it fixed.↗
Mark's statements about Pediatric Oncology2 statements
quoteIt's hard to believe that the appendix doesn't scar uh somewhat due the inflammation, which may predispose it to developing an obstruction and acute appendicitis later.↗
▶Ep 155 · 24:39
quoteI think the parents are more focused on the here and now, that is what's happening at that moment in the emergency room, whereas we as their caregivers need to be thinking about what's best for the total life of the patient↗
clinicalIn micro-preemies (1000g to 2kg), a 3-French soft silastic catheter is preferred because larger catheters as big as the vessel can cause vessel thrombosis.↗
▶Ep 3 · 1:30
quotereally in the micro preemie, if you're talking about a 1000 g baby or even even up to maybe a 2 kg baby, I tend to use three French soft silastic catheter↗
▶Ep 3 · 2:33
clinicalNeedle-hole venotomy technique: isolate the internal jugular vein, make a needle hole with the kit needle, and slide the pre-tunneled catheter into that hole without ligating the vein, preserving it for future access.↗
▶Ep 3 · 2:33
quoteI actually just put it, make a needle hole with the needle that comes in the kit in the vein, and then I have the catheter already tunneled and trimmed. And I will slide the catheter into that needle hole so that you don't ligate the vein. I don't tie it off.↗
▶Ep 3 · 3:23
clinicalBeveling the catheter end is associated with slightly more catheter thrombosis than cutting straight across, but may be worth it to preserve the vein in micro-preemies.↗
▶Ep 3 · 13:36
guidelineSubcutaneous ports (port-a-cath, meta-port) are used for most intermittent chemotherapy; cuffed lines (Broviac) are used for highly toxic agents like Adriamycin that cause tissue necrosis if infiltrated.↗
▶Ep 3 · 14:32
clinicalBone marrow transplant patients often require three lumens: a double-lumen perm-cath plus a single-lumen line.↗
▶Ep 3 · 14:57
clinicalThe smallest mini-port available is 5-French and can be placed in a 7-8 kg infant, though it requires special order.↗
▶Ep 3 · 15:34
guidelineMRV is the gold standard for pre-operative vascular imaging in patients with multiple prior lines or history of DVT.↗
▶Ep 3 · 17:53
clinicalA glide wire can sometimes pass through venous thrombosis when a standard wire cannot, finding a channel through the clot.↗
▶Ep 3 · 17:53
quoteI took a glide wire and you can take the actually, you know, I said I did a subclavian stick. I actually did an IJ with ultrasound guidance on the right side is what I did, but I used a glide wire. Then I was able to pass the glide wire through the clot.↗
▶Ep 3 · 22:03
clinicalFemoral lines in babies often result in leg swelling and DVT, so they are avoided in that population.↗
▶Ep 3 · 24:40
guidelineInstitutional heparin lock protocol: 10 units/mL for accessed lines (ports or cuffed lines), 100 units/mL for buried ports, and 1000 units/mL for dialysis catheters (which is withdrawn before use).↗
▶Ep 3 · 26:16
guidelineFor gram-positive line infections, ethanol lock plus antibiotics through the catheter can clear the infection; for gram-negative infections, success rate is approximately 50%; for fungal infections (Candida), the line must be removed.↗
▶Ep 3 · 26:16
quoteIf it's gram positive, we will, you know, do ethanol lock. We'll treat with antibiotics through the catheter and try to clear the catheter. If it's gram negatives or yeast, the chances of clearing it are much less.↗
▶Ep 3 · 27:41
epidemiologicalAntibiotic-coated and heparin-coated temporary catheters have been shown to decrease catheter-associated bloodstream infection rates.↗
▶Ep 3 · 28:26
clinicalThoracoscopic-guided trans-mediastinal puncture technique: advance a needle through the thrombosed IJ track into the superior vena cava under thoracoscopic visualization; the SVC almost always recanalizes where the azygous vein enters.↗
▶Ep 3 · 28:26
quotewe took a needle through the neck along the thrombosed IJ into the superior vena cava and basically advanced the needle until we got blood back and really at the where the azygous vein comes into the superior vena cava the SVC almost always recantalizes↗
▶Ep 3 · 29:53
clinicalFor thoracoscopic salvage access in larger patients (17-year-old mentioned), the standard kit needle may not be long enough and an extra-long spinal needle is required.↗
▶Ep 3 · 31:17
opinionThere is speculation (without definitive evidence) that betadine exposure causes silicone catheter deterioration, making old lines chalky and difficult to remove.↗
▶Ep 3 · 32:46
clinicalBroviac cuffs placed far from the exit site are designed to break away with slow, steady traction, allowing bedside removal without cuff excision.↗
▶Ep 3 · 33:14
clinicalIn 17-18 years of practice, only one retained cuff developed infection requiring incision and drainage.↗
Mark's statements about Vascular Access22 statements
clinicalIn micro-preemies (1000g to 2kg), a 3-French soft silastic catheter is preferred because larger catheters as big as the vessel can cause vessel thrombosis.↗
▶Ep 4 · 1:30
quotereally in the micro preemie, if you're talking about a 1000 g baby or even even up to maybe a 2 kg baby, I tend to use three French soft silastic catheter↗
▶Ep 4 · 2:33
clinicalNeedle-hole venotomy technique: isolate the internal jugular vein, make a needle hole with the kit needle, and slide the pre-tunneled catheter into that hole without ligating the vein, preserving it for future access.↗
▶Ep 4 · 2:33
quoteI actually just put it, make a needle hole with the needle that comes in the kit in the vein, and then I have the catheter already tunneled and trimmed. And I will slide the catheter into that needle hole so that you don't ligate the vein. I don't tie it off.↗
▶Ep 4 · 3:23
clinicalBeveling the catheter end is associated with slightly more catheter thrombosis than cutting straight across, but may be worth it to preserve the vein in micro-preemies.↗
▶Ep 4 · 13:36
guidelineSubcutaneous ports (port-a-cath, meta-port) are used for most intermittent chemotherapy; cuffed lines (Broviac) are used for highly toxic agents like Adriamycin that cause tissue necrosis if infiltrated.↗
▶Ep 4 · 14:32
clinicalBone marrow transplant patients often require three lumens: a double-lumen perm-cath plus a single-lumen line.↗
▶Ep 4 · 14:57
clinicalThe smallest mini-port available is 5-French and can be placed in a 7-8 kg infant, though it requires special order.↗
▶Ep 4 · 15:34
guidelineMRV is the gold standard for pre-operative vascular imaging in patients with multiple prior lines or history of DVT.↗
▶Ep 4 · 17:53
quoteI took a glide wire and you can take the actually, you know, I said I did a subclavian stick. I actually did an IJ with ultrasound guidance on the right side is what I did, but I used a glide wire. Then I was able to pass the glide wire through the clot.↗
▶Ep 4 · 17:53
clinicalA glide wire can sometimes pass through venous thrombosis when a standard wire cannot, finding a channel through the clot.↗
▶Ep 4 · 22:03
clinicalFemoral lines in babies often result in leg swelling and DVT, so they are avoided in that population.↗
▶Ep 4 · 24:40
guidelineInstitutional heparin lock protocol: 10 units/mL for accessed lines (ports or cuffed lines), 100 units/mL for buried ports, and 1000 units/mL for dialysis catheters (which is withdrawn before use).↗
▶Ep 4 · 26:16
guidelineFor gram-positive line infections, ethanol lock plus antibiotics through the catheter can clear the infection; for gram-negative infections, success rate is approximately 50%; for fungal infections (Candida), the line must be removed.↗
▶Ep 4 · 26:16
quoteIf it's gram positive, we will, you know, do ethanol lock. We'll treat with antibiotics through the catheter and try to clear the catheter. If it's gram negatives or yeast, the chances of clearing it are much less.↗
▶Ep 4 · 27:41
epidemiologicalAntibiotic-coated and heparin-coated temporary catheters have been shown to decrease catheter-associated bloodstream infection rates.↗
▶Ep 4 · 28:26
quotewe took a needle through the neck along the thrombosed IJ into the superior vena cava and basically advanced the needle until we got blood back and really at the where the azygous vein comes into the superior vena cava the SVC almost always recantalizes↗
▶Ep 4 · 28:26
clinicalThoracoscopic-guided trans-mediastinal puncture technique: advance a needle through the thrombosed IJ track into the superior vena cava under thoracoscopic visualization; the SVC almost always recanalizes where the azygous vein enters.↗
▶Ep 4 · 29:53
clinicalFor thoracoscopic salvage access in larger patients (17-year-old mentioned), the standard kit needle may not be long enough and an extra-long spinal needle is required.↗
▶Ep 4 · 31:17
opinionThere is speculation (without definitive evidence) that betadine exposure causes silicone catheter deterioration, making old lines chalky and difficult to remove.↗
▶Ep 4 · 32:46
clinicalBroviac cuffs placed far from the exit site are designed to break away with slow, steady traction, allowing bedside removal without cuff excision.↗
▶Ep 4 · 33:14
clinicalIn 17-18 years of practice, only one retained cuff developed infection requiring incision and drainage.↗
Summaries Mark gave as host
· 27 summaries
Recaps of what the experts said, with Mark as narrator — not Mark's own clinical position, and never cited in answers.
Summaries Mark gave as host · Button Battery Ingestion2 summaries
Journal of pediatric surgery Article Review: April 2023, IPEG issue
▶Ep 4 · 6:33
host summaryMark Wulkan summarizing the discussion: The risk score for button battery ingestion can help determine whether transfer to a specialized facility is needed.↗
▶Ep 4 · 10:32
host summaryMark Wulkan summarizing the discussion: There was no significant difference in post-operative cholangitis or mortality between laparoscopic and open choledochal cyst resection despite different anastomosis types.↗
Summaries Mark gave as host · Choledochal Cyst / Biliary2 summaries
Journal of pediatric surgery Article Review: April 2023, IPEG issue
▶Ep 4 · 6:33
host summaryMark Wulkan summarizing the discussion: The risk score for button battery ingestion can help determine whether transfer to a specialized facility is needed.↗
▶Ep 4 · 10:32
host summaryMark Wulkan summarizing the discussion: There was no significant difference in post-operative cholangitis or mortality between laparoscopic and open choledochal cyst resection despite different anastomosis types.↗
host summaryMark Wulkan summarizing a resource: The atrial-caval junction is actually much deeper on chest X-ray than most surgeons think, not at the visible indentation where the silhouette widens.↗
▶Ep 5 · 9:13
host summaryMark Wulkan summarizing a resource: the interventional radiologist came and showed me a great article that showed that we are, most of us put these too high where we think the atrial caval junction is actually much lower than we think↗
▶Ep 5 · 10:25
host summaryMark Wulkan summarizing a resource: A 2013 JACS study by Sanj Dutta, Sean St. Peter and others showed ultrasound guidance achieved first-stick success in 65% of patients versus 45% with landmark technique, and 95% success by three attempts versus 74%.↗
▶Ep 5 · 11:25
host summaryMark Wulkan summarizing a resource: In the adult literature, the number of needle sticks is a good proxy marker for the risk of complications.↗
▶Ep 5 · 11:25
host summaryMark Wulkan summarizing a resource: 65% of the patients in the ultrasound group had one stick, whereas only 45% in the landmark group. And with and if you look at the number, the success by 3 attempts, it was 95% in the ultrasound group versus 74% in the landmark group.↗
▶Ep 5 · 31:17
host summaryMark Wulkan summarizing a resource: The APSA Outcomes Committee meta-analysis in 2011 found Class A or B evidence that chlorhexidine-alcohol prep decreases line infections compared to betadine.↗
Guillermo Ares, MD and Mark Wulkan, MD - 2024 Pediatric Bariatric Surgery Update Course
▶Ep 19 · 9:19
host summaryMark Wulkan summarizing the discussion: Large comparative studies show really no difference in outcomes between robotic and laparoscopic bariatric surgery.↗
▶Ep 19 · 10:20
host summaryMark Wulkan summarizing the discussion: A large study shows there may be a little bit of increase in infectious complications with robotic surgery.↗
▶Ep 19 · 10:46
host summaryMark Wulkan summarizing the discussion: In the MBSAQIP database study of almost 800,000 patients, robotic Roux-en-Y had slightly lower infectious complications, but with sleeve it was higher, and robotic surgeries had higher 30-day readmission and reoperative rates.↗
Summaries Mark gave as host · Pectus Excavatum2 summaries
Journal of pediatric surgery Article Review: April 2023, IPEG issue
▶Ep 31 · 6:33
host summaryMark Wulkan summarizing the discussion: The risk score for button battery ingestion can help determine whether transfer to a specialized facility is needed.↗
▶Ep 31 · 10:32
host summaryMark Wulkan summarizing the discussion: There was no significant difference in post-operative cholangitis or mortality between laparoscopic and open choledochal cyst resection despite different anastomosis types.↗
Summaries Mark gave as host · Thrombosis6 summaries
host summaryMark Wulkan summarizing a resource: The atrial-caval junction is actually much deeper on chest X-ray than most surgeons think, not at the visible indentation where the silhouette widens.↗
▶Ep 3 · 9:13
host summaryMark Wulkan summarizing a resource: the interventional radiologist came and showed me a great article that showed that we are, most of us put these too high where we think the atrial caval junction is actually much lower than we think↗
▶Ep 3 · 10:25
host summaryMark Wulkan summarizing a resource: A 2013 JACS study by Sanj Dutta, Sean St. Peter and others showed ultrasound guidance achieved first-stick success in 65% of patients versus 45% with landmark technique, and 95% success by three attempts versus 74%.↗
▶Ep 3 · 11:25
host summaryMark Wulkan summarizing a resource: In the adult literature, the number of needle sticks is a good proxy marker for the risk of complications.↗
▶Ep 3 · 11:25
host summaryMark Wulkan summarizing a resource: 65% of the patients in the ultrasound group had one stick, whereas only 45% in the landmark group. And with and if you look at the number, the success by 3 attempts, it was 95% in the ultrasound group versus 74% in the landmark group.↗
▶Ep 3 · 31:17
host summaryMark Wulkan summarizing a resource: The APSA Outcomes Committee meta-analysis in 2011 found Class A or B evidence that chlorhexidine-alcohol prep decreases line infections compared to betadine.↗
Summaries Mark gave as host · Vascular Access6 summaries
host summaryMark Wulkan summarizing a resource: The atrial-caval junction is actually much deeper on chest X-ray than most surgeons think, not at the visible indentation where the silhouette widens.↗
▶Ep 4 · 9:13
host summaryMark Wulkan summarizing a resource: the interventional radiologist came and showed me a great article that showed that we are, most of us put these too high where we think the atrial caval junction is actually much lower than we think↗
▶Ep 4 · 10:25
host summaryMark Wulkan summarizing a resource: A 2013 JACS study by Sanj Dutta, Sean St. Peter and others showed ultrasound guidance achieved first-stick success in 65% of patients versus 45% with landmark technique, and 95% success by three attempts versus 74%.↗
▶Ep 4 · 11:25
host summaryMark Wulkan summarizing a resource: 65% of the patients in the ultrasound group had one stick, whereas only 45% in the landmark group. And with and if you look at the number, the success by 3 attempts, it was 95% in the ultrasound group versus 74% in the landmark group.↗
▶Ep 4 · 11:25
host summaryMark Wulkan summarizing a resource: In the adult literature, the number of needle sticks is a good proxy marker for the risk of complications.↗
▶Ep 4 · 31:17
host summaryMark Wulkan summarizing a resource: The APSA Outcomes Committee meta-analysis in 2011 found Class A or B evidence that chlorhexidine-alcohol prep decreases line infections compared to betadine.↗
