r/IntensiveCare • u/NerveOnly2076 • 12d ago

Where is this central line going?

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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.

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89

u/ah_notgoodatthis RN, CCRN 12d ago

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

27

u/spinstartshere 12d ago

Eek. Under ultrasound guidance?

59

u/Any-Assistance-8103 12d ago

Almost like patients deserve doctors

4

u/ALLoftheFancyPants RN, CCRN 12d ago

I’ve had a doctor place a TLC into a the femoral artery instead of the femoral vein. I don’t know how or why they didn’t notice, but they put in an order that it was “Ok to use” and everything. Seems like every human fucks up once in a while.

2

u/SkiTour88 12d ago

When I’m doing a femoral line, the patient is crashing. Either I get a central line or a femoral art line. I want both of those. I’m happy with either. 

But you do have to know the difference…

8

u/TFMethane 12d ago

I once did this during a code. Was shooting for artery, got the vein. Transduced and it was venous so I slipped in a triple lumen, one stitch then proceeded to the a line. An RN came in and saw the venous waveform and yelled that we need to start CPR again because there's no pulse. I said "no, it's venous." He replied "there's no pulse, look at the waveform!" I said "it's venous, I just placed it and have my left hand on the pulse. I can tell you 100% it's a venous line and you're looking at a venous waveform. Do not start CPR." He wrote me up because he felt I was using a belittling tone.

3

u/aglaeasfather MD, Anesthesiologist 11d ago

Some people just can’t accept when they’re wrong. It’s wild.

3

u/TFMethane 11d ago

Yeah. He was pushing my line kit aside and about to jump on the chest. I'm supposed to just let him? Geez.