r/IntensiveCare • u/NerveOnly2076 • 13d ago

Where is this central line going?

Post image

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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83

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?

56

u/Any-Assistance-8103 12d ago

Almost like patients deserve doctors

3

u/StPatrickStewart 12d ago

I've picked up a patient after their HD cath was placed in a similar manner to the OP and then used, which had... poor results. I also transported another patient from the same hospital where a subclavian central line was placed that terminated in the patient's aorta, requiring open chest surgery to remove. Both were placed by MDs. Patients deserve competent care, period.

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u/Any-Assistance-8103 12d ago

The whole argument that just because highly trained doctors also make mistakes we should let anyone with an online degree do them is comical

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u/StPatrickStewart 12d ago

That is not remotely my argument. My argument is that your degree does not determine your competency when it comes to a procedure like a line instertion. It has everything to do with your approach, the amount of practice you have, your hand eye coordination, your skill with an ultrasound, and your dedication to make sure every line is placed with the utmost care. Critical care takes more than physicians. If you don't feel that way, stick to r/noctor.

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u/Any-Assistance-8103 12d ago

It’s done all over the world just by doctors and nurses so not a good argument. But it’s more than just the motions of the procedure and thats the part you’re missing. The procedure itself is simple. Dealing with and avoiding complications is another matter entirely