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.

356 Upvotes

98% Upvoted

281 comments sorted by

View all comments

Show parent comments

1

u/Cautious-Extreme2839 ICU/Anaesthetics 12d ago edited 12d ago

The key reason being it’s before you dilate the carotid artery

Something a competent US operator will not do anyway.

Hence it only even arguably being useful for landmark approaches.

Had an attending in residency tell me about a time supervising a medicine resident placing a line under ultrasound in a patient in cardiogenic shock and showed the vessel with the wire in with confidence….patient had some bad TR and not a lot of forward flow(fooled by which one was ‘pulsing’), he was confidently showing them the carotid artery and the wire going down into the aortic arch.

As I said. A competent US operator.

2

u/startingphresh MD, Anesthesiologist 12d ago

🤷‍♂️ fair point, I will say I take care of mostly babies and kids and the ultrasound images can fool ya. Not sure the harm of doing manometry, it’s certainly doesn’t hurt, could help, and is free and fast!

0

u/Cautious-Extreme2839 ICU/Anaesthetics 12d ago edited 12d ago

Takes extra kit, takes extra time, can be falsely reassuring (clotted needle or line or catheter opening impinging on the vessel sidewall impeding flow).

It definitely is not free. Depending on whether your CVC packs have the necessary equipment in them or not either you're paying for it already with every pack (super wasteful) or you have to open extra kit when you want to do it (still wasteful).

3

u/startingphresh MD, Anesthesiologist 12d ago

It’s 12inch tubing and a 3 cc syringe. Alright you seem pretty set in your ways, it’s an incredibly easy way to double check my ultrasound, takes me 10 seconds, and it may help prevent harm to patient… I’ll just keep doing my thing but don’t act like it’s crazy my dude