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In intensive care, CVP line or short line, in nephrology ward, an  IJC for dialysis are very frequent procedure.

I just started my nephrology rotation this month and I found out that inserting IJC is safe and fast procedure (at least for those first timer) with assistance from Ultrasound.

It’s contrasted with my past experience of attempting to insert CVP line with blind technique.

Even more, I just found that NICE is recommend 2D ultrasound as a tool for CVP insertion.

Complete summary as follow: URL:

2-D imaging ultrasound guidance should be the preferred method when inserting of central venous catheter into the internal jugular vein in adults and children in ‘elective situations’. (‘Elective situation’ means that the operation, or other treatment, has been planned – that is, it is not an emergency.)

2-D imaging ultrasound guidance should be considered in most clinical situations where CVC insertion is necessary, whether the situation is elective or an emergency.

Everyone who uses 2-D imaging ultrasound guidance to insert central venous catheters should have appropriate training to ensure they are competent to use the technique.

Audio-guided Doppler ultrasound guidance is not recommended for use when inserting central venous catheters.


A quick search at google  reveal the meaning of miracle.

Miracle —–An event inexplicable by the laws of nature

Have you encounter miracle in your life?

No, I don’t believe in miracle.

Wait… just ponder for a second..

Miracle happening everywhere…

let’s take an example..


Let take a disease which cause so much mortality and morbidity,

back to 50 years ago, it may be a dead sentence for a young man who diagnosed of pulmonary tuberculosis,…..

But now, the widely available of antibiotics effectively provide a CURE…a miracle indeed,

Back to the 80s,  contracted AIDS is getting a dead sentence. There were no appeal for the sentence, you get weak days by days and soon died in bout of opportunistic infection. HEY …. wait a minute….. There are Miracles …. discovery of new anti-viral,  combination of with multiple drugs – given so call a cocktail therapy,  prophylaxis against opportunistic infection, safe sex, and so many more. Till today,  we are still waiting for two miracles, the available of a vaccine and a complete eradication of virus in the body….

Yup, miracle  is man-make.

We should work harder for our life.

Miracle don’t wait for lazy fellows.

It’s happened 8 years ago on 11th September 2001.

Back then, I still working at  a Singapore bank and was a year away from quitting-job-enrol-medicine-school.

It’s about 9 pm when I tuned to satellite TV  TVBS channel. I first noted it shows a burning building.  After a short while, I just realised that the burning building was the Pentagon. I was surprised and when I switched to CNN, even bigger surprise, the World trade center had been attacked.

September 2009
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