disaster line

[doctorFred]

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hit big red and dropped a lung all in one attempt on a central line, and it wasn't even a subclave.. it was an IJ.

officially, my first (and second) major central line complications. of course, i subsequently got a chest tube out of it, and my upper year and attending were both great about it, but i feel like a chump. especially because i've never heard of someone dropping a lung on an IJ (and i think i once laughed at someone who mentioned it as a potential complication.)

i guess my angle was too shallow. anyone else done (or seen it) before?

 

[Arcan57]

It's a recognized complication. It's not common (0-0.2%), but it still doesn't come close to the U/S guided vertebral artery line that happened to an intern at my program.

 

[gro2001]

Any reason why the patient would have hyper-inflated lungs? COPD and high tidal volume on a vent both increase the possibility of the cupola extending to the neck.

 

[doctorFred]

i did actually tube her just prior to the line attempt so yeah, she was vented, volumes at 500 i think. i didn't think about that, but if true, it makes me feel 1% better.

 

[roja]

Add in frail, thin individuals. Anyone laughing at you has probably forgotten thier anatomy. The apices of the lung rise above the clavicles.

With ultrasound, I think both these complications are less. but still possible if you are moving the needle around.