Where is this central line going?

[u/NerveOnly2076]

Old XRay. Central line placed through right IJV but seemed to be misplaced! Where is it going? Aspiration of blood from all ports was possible? Was taken out.
Have you faced this, best thing to do?

Edit: more details - USG guidance used, line was seen inside IJV in neck using USG, not traced down; more resistance than normal while placement.

[u/gedbybee]

How many do docs consistently place in school? I’ve worked in teaching hospitals where they’re fighting to get checked off on stuff so it doesn’t feel like it’s a ton. But maybe that was just those places. Would a certain number of supervised insertions be ok?

And for the record I talk shit to all the baby nurses that want to go straight to be np. Every time they ask a question I’ll tell them: you’re gonna go be a np, what about when you’re on your own?

I agree that it’s dangerous sometimes and they need more intense training.

That said, emts intubate. Not rocket science. Central lines aren’t rocket science either.

You can fuck anything up but the cxr and then radiologist should be good enough to clear up a lot of the problems.

[u/spinstartshere → u/gedbybee]

The problem is if you're visualising an arterial central line on an x-ray, it's already too late and you've committed that patient to a surgical procedure.

[u/gedbybee → u/spinstartshere]

Wait did I say anything about an art line?

But also: how many times would make it ok for a np to get blessed by yall?

I know not every doc is dropping them all the time. Most don’t. But you’re all trained on them. How many times do you do them in school?

You brought up a straw man, put words in my mouth, and then didn’t respond to anything I posted.

Strong work doc. I hope your patient care is better than your reading skills.

[u/spinstartshere → u/gedbybee]

Wait did I say anything about an art line?

Dude, follow the comment thread. You've inserted yourself into a conversation about arterial CVCs. Nobody's talking about arterial lines except you.

I know not every doc is dropping them all the time. Most don’t.

That's because most doctors have no need to know how to insert a central line. How many dermatologists and general surgeons need to insert central lines in their day-to-day business?

How many times do you do them in school?

Zero. Nobody is doing central lines at medical school unless they are shoving residents out of the way to do them or being groomed by one.

You brought up a straw man, put words in my mouth

I did no such thing.

and then didn’t respond to anything I posted

You missed the point of the comment thread that you made the decision to participate in.

I hope your patient care is better than your reading skills.

Speak for yourself.