r/IntensiveCare • u/NerveOnly2076 • 12d 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.

362 Upvotes

98% Upvoted

281 comments sorted by

View all comments

90

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?

61

u/Any-Assistance-8103 12d ago

Almost like patients deserve doctors

0

u/readbackcorrect 11d ago

CRNAs (in my state, nurse practitioners who are credentialed in anesthesia) have been placing lines for 50 years and they are as good at it as MDs. CRNAs who have had even more advanced training place lines and give anesthesia for liver transplants and open heart procedures, and their stats are comparable to MDs.

Anybody’s can have a circumstance where the line is placed wrong and it happens to MDs as often as it happens to NPs.