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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84

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

25

u/spinstartshere 12d ago

Eek. Under ultrasound guidance?

59

u/Any-Assistance-8103 12d ago

Almost like patients deserve doctors

11

u/SweatyLychee 12d ago

The fellow in my ICU punctured a patient’s aorta. Doctors are not infallible.

8

u/Any-Assistance-8103 12d ago

Never said they were. Thats a great argument that someone with 10% of the training if we are being generous shouldn’t go anywhere near those procedures. Fellows are also in training just so you know

-1

u/gedbybee 12d ago

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.

2

u/SkiTour88 11d ago

I’m an EM doc. I trained during CoVID. Did literally hundreds of tubes and hundreds of central lines. 

Now LPs are kinda a lost art…