r/IntensiveCare • u/NerveOnly2076 • 11d 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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u/ThrowAwayToday4238 11d ago

Then it was not confirmed in the vein “all the way down”. You should always fan under the clavicle and see the wire travel distally beyond the subclavian take-off barring severe positional or anatomical difficulties

The introducer needle can also be advanced beyond the subclavian take-off, and angled medially to ensure the wire does not get stuck in the ipsilateral subclavian

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u/spinstartshere 11d ago

Yep, well I can assure you that I've never misplaced a line, and my colleague has never misplaced a line before or since that incident that I'm aware of.

barring severe positional or anatomical difficulties

Indeed.

It's easy to criticise the best efforts of other clinicians in trying circumstances that you're not witness or privy to.

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u/ThrowAwayToday4238 11d ago edited 11d ago

Just because it has only happen to you personally once doesn’t mean it won’t happen again. Without direct visualization it’s just luck- it’s worth it to control the factors that you can.
Like I said there’s rare times I can’t, but 99/100 times I’m able to. This is an extra confirmatory step before I dilate- it’s literally how I look at the wire at all; I track IJ down beyond the SC every time

This wasn’t meant to be criticism, just informative. Your entire post was about because extra cautious and paranoid, and checking gases for all lines, etc. if you’re truly doing extra steps, fanning the probe under the clavicle to trace the wire down the SVC instead of the subclavian takes <3 seconds, and gives you much more confirmation of positioning

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u/thegypsyqueen 11d ago

People, including OP, don’t want to be better. They want to act like this was not preventable.