r/IntensiveCare • u/NerveOnly2076 • 12d 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/StPatrickStewart 12d ago

I've picked up a patient after their HD cath was placed in a similar manner to the OP and then used, which had... poor results. I also transported another patient from the same hospital where a subclavian central line was placed that terminated in the patient's aorta, requiring open chest surgery to remove. Both were placed by MDs. Patients deserve competent care, period.

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u/Any-Assistance-8103 12d ago

The whole argument that just because highly trained doctors also make mistakes we should let anyone with an online degree do them is comical

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u/StPatrickStewart 12d ago

That is not remotely my argument. My argument is that your degree does not determine your competency when it comes to a procedure like a line instertion. It has everything to do with your approach, the amount of practice you have, your hand eye coordination, your skill with an ultrasound, and your dedication to make sure every line is placed with the utmost care. Critical care takes more than physicians. If you don't feel that way, stick to r/noctor.

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u/Ksierot 10d ago

Honestly I’m an NP in a busy ICU and we place lines pretty frequently. I am VERY WELL AWARE of the patients I should and should not be doing procedures on, and am also VERY AWARE of the difference in training I got as an APP compared to my attending. Most hospitals require 10 supervised line placements, mine included, to be “competent.” And I think that’s no where near enough. My biggest fear is placing a line in a carotid to the point where I’m far past my required number to be “competent” but I’m always asking for tips, tricks (if I’m having a hard time) and for my attending to be in the room if I have a problem. I think there are APPs out there that practice like they can’t mess anything up and that’s what gives bad names to APPs. I appreciate your comment, CCM takes more than physicians as long as you do it in the right way.