how many lines

[JackADeli]

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I spoke with a resident about the IJ vs SC debate....
He told me about an ICU patient that had their ETT balloon popped by the intensivist when trying to place an IJ!!!

I have also been on the vascular service during GSurgery residency and done several consults for repair of SC/Inom-aorta junction repair consults from an attempted IJ.

 

[proman]

I have also been on the vascular service during GSurgery residency and done several consults for repair of SC/Inom-aorta junction repair consults from an attempted IJ.

Introducers? I've heard of dilators folding over while being advanced and ripping the brachiocephalic vein. Those patients die.

 

[JackADeli]

Introducers? I've heard of dilators folding over while being advanced and ripping the brachiocephalic vein. Those patients die.

The two I know of lived... but had a big scar to show for it.

 

[SLUser11]

For CVLs, they never do it sterile enough, they always place a big 8.5 french Cordis, which isn't necessary, they always do an IJ, rarely use ultrasound, usually put one stitch in it, and then thread the 30cm 2-lumen line (with swandom) through. The next day, if the line survived the night, it is flapping around in the wind without any protection, with lots of patient slobber all over it, and the 2-lumen is almost surely pulled out far enough where the tip is inside the cordis.

Had another one that I noticed yesterday. I missed a big septic belly case due to Norwalk virus (first sick day since I started medicine...felt pretty wimpy but I was unsafe to be around pts).....walked into the ICU to see the pt yesterday, and the primarily chosen left IJ line was a big mess....flopping in the wind, cordis kinked on itself in the neck, and of course the 30 cm catheter thread through the cordis...I could see the 5cm mark outside the cordis, so....