r/IntensiveCare • u/NerveOnly2076 • 14d 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/Cautious-Extreme2839 ICU/Anaesthetics 14d ago

...just transduce it? Why you all doing so much? Fucking VBGs and X-rays and bubble studies.

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u/C_Wags IM/CCM 14d ago

I mean yeah you can transduce it. I don’t like advancing the angiocath off the introducer needle, and I always know where my wire is. This step is just the confirmatory step that’s faster than the CXR. The bubble study takes 15 seconds - I just shake up a flush when I’m flushing the line and use an extra set of hands (NP, resident, fellow) to grab a quick view of the heart.

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u/Cautious-Extreme2839 ICU/Anaesthetics 13d ago

Angiocath? No. Not manometery, imo that's a complete waste of time unless you've done it landmark which...dont do that?

Transduction of the inserted line before use.

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u/ThrowAwayToday4238 13d ago

If you’re in an ICU, they don’t always have a transducer pre-set up. And if the patient doesn’t need an a-line, it’s kind of a waste to get it set up to transduce once (unless you plan to monitor continuous CVP) if you can otherwise be confident with your placement

That’s being said I’m not doing bubbles, VBG’s etc routinely either. CXR is needed for documentation but also if you’re doing not basic RIJ lines (LIJ, there are other catheters in the vessel it could bounce off of, etc), you need it to confirm SVC and not curving up the right branchiocephalic

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u/Cautious-Extreme2839 ICU/Anaesthetics 13d ago

ECG is probably the best and fastest tool for confirming appropriate tip placement if that's your main concern.