Advice on difficult central line technique

[Bobblehead]

---

Members don't see this ad.

Is there any collective wisdom on difficult central line technique?

By this I mean someone who appears to be appropriately positioned for either a SC or IJ approach (flat or Trendelenburg) perhaps with a shoulder roll, arms down by the side, adequately sedated/relaxed. Someone else has already attempted the central line, and there may be some distortion of the insertion site due to hematoma formation.

If no US is available do you convert to the alternative side without significantly repositioning the patient assuming this can be done cleanly (site already prepped)?

If after US evaluation you determine the SC just isn't a good candidate for more attempts do you move to the IJ and if you do, do you move to the head of the bed or place the IJ from the side of the bed under US guidance?

If you get flow but suspect central obstruction due to the inability to advance the guidewire significantly beyond the tip of the needle do you reposition the needle? How many times do you do so before moving to another site?

Any other situations people have encountered here?

 

[gasnewby]

If no US is available do you convert to the alternative side without significantly repositioning the patient assuming this can be done cleanly (site already prepped)?

NO, the only two sites that should be prepped are the ipsilateral IJ and SC. You cannot switch SIDES without checking a cxr to make sure you didn't drop one lung. You drop two lungs = dead patient.

http://forums.studentdoctor.net/showthread.php?t=290182&highlight=central+line

 

[Bobblehead]

NO, the only two sites that should be prepped are the ipsilateral IJ and SC. You cannot switch SIDES without checking a cxr to make sure you didn't drop one lung. You drop two lungs = dead patient.

http://forums.studentdoctor.net/showthread.php?t=290182&highlight=central+line

Sorry, to clarify side = site as in the ipsilateral IJ/SC.