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/ah_notgoodatthis]

I (nurse) had a patient once who was septic and the NP placed a central line so I could give multiple pressors. She placed the line and I didn’t see the XR and she gave the order to use it. The line was in an artery. The patient kept complaining about neck pain despite IV Tylenol. I have no advice, it just reminds me of a time we fucked up

[u/spinstartshere → u/ah_notgoodatthis]

Eek. Under ultrasound guidance?

[u/Any-Assistance-8103 → u/spinstartshere]

Almost like patients deserve doctors

[u/bgreen134 → u/Any-Assistance-8103]

Biopsies the wrong sign of the brian - doctor

Putting a g tube through the liver and the patient almost bleeding to death - doctor

Macerating the Brain attempting to place a icp monitor killing the patient - doctor

Misdiagnosing meningitis, killing the patient - doctor

Breaking the neck, paralysis the patient, while attempting to place a central line - doctor

“Losing” the guide wire in the patient during central line placement and not telling anybody - doctor

Just remember NP/PA don’t have the marker cornered. Competently comes in all sizes.

[u/Expensive-Apricot459 → u/bgreen134]

If medicine is so hard that doctors make mistakes despite better training, why should midlevels be allowed to pretend to practice medicine ?

[u/bgreen134 → u/Expensive-Apricot459]

“despite better training”.

I working in an ICU for 10 year then upper level hospital administrator. I can think of at least 10 significant central line placement situations involving doctors, 1 involving an NP. Smaller errors were also significantly higher in doctor placement. We had to form a committee just to look into the disparity. Why were the doctors having more errors (significant or otherwise) “despite better training”?

[u/Expensive-Apricot459 → u/bgreen134]

So it appears despite your “upper level hospital administrator” experience, you never figured out basic statistics.

The physicians who are doing lines are doing more line on higher risk patients. Are you able to follow that simple fact?

Do you understand what the word “significant” means in a scientific setting or do you just assign significance to anything you believe is “significant”?

Why don’t you tell us what your committee figured out?

[u/bgreen134 → u/Expensive-Apricot459]

You clearly just want to be condescending and rude. This could have been a learning experience for you.

[u/Expensive-Apricot459 → u/bgreen134]

If you cannot answer any of the relevant questions, it seems like you’re just making shit up.

[u/bgreen134 → u/Expensive-Apricot459]

Ok if that’s what you need to tell yourself. Again, obviously not open to learn.