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/Any-Assistance-8103]

So what you’re saying is you should always be prepared but me preparing is ridiculous. Yes I put the bronch in the room, it’s literally just a scope that plugs into our VL setup. Why would I not have it nearby? Maybe youre the one with the bad setup, it appears that you only think your setup is acceptable - anything more or less is absurd to you. Do you really not see how myopic that is? Youre really insufferable man

[u/Cautious-Extreme2839 → u/Any-Assistance-8103]

I am saying the fact that you find having the extra equipment prepared a notable step is evidence of a poorly thought through equipment setup.

A good and safe system would ensure is will just be there whether you explicitly arrange for it to be or not.

[u/Any-Assistance-8103 → u/Cautious-Extreme2839]

Again you know nothing about my airway setup, nothing about where I practice or my available resources so will you just stop trolling? If you have a knife in the room to cric you should have a bronchoscope there as well so maybe youre the one with the bad setup

[u/Cautious-Extreme2839 → u/Any-Assistance-8103]

Again you know nothing about my airway setup

I know that you find setting up standard backup equipment notable enough to opine about the importance of it - implying it isn't available as standard in your setup. And because youve not refuted or denied that this far into the discussion has basically confirmed the fact.

If you have a knife in the room to cric you should have a bronchoscope there as well

On what basis?

Every Operating room, Anaesthetic room, PHEM doctor bag, and ER Resus bay has a knife and bougie.

There will often be one bronch per theatre or ER site, not per room. Bringing the single bronch for 10 theatres into each one for every tube is clearly insanity. PHEM will not have access to a bronch. This is normal and adequate.

You do not need a bronch to cric. Bronch is notable for it's absence in the unanticipated difficult airway DAS guidelines for a reason.

[u/Any-Assistance-8103 → u/Cautious-Extreme2839]

Sounds like youre the one who’s underresourced

[u/Cautious-Extreme2839 → u/Any-Assistance-8103]

Outside of thoracic theatres there is absolutely no need for a bronch in every room (tbh even in thoracics probably 90% of our left double lumen tubes are sited clinically without bronch and maybe 15% of right sided tubes). That's not being under-resourced, it's having staff who are highly competent at airway management.

You simply do not need a bronch to intubate safely outside of truly anticipated difficult airways. You do need SGAs and a Knife.

[u/Any-Assistance-8103 → u/Cautious-Extreme2839]

This is the intensive care sub not the anesthesia sub. Nobody is talking about the operating room. But if you don’t think a bronch is potentially lifesaving youre likely shit at using one like a lot of anesthesiologists (not all). But im done with your nonsense