Line Access and Infection: clinical question


Full Member
7+ Year Member
Jun 20, 2013
  1. Attending Physician
    We had a case where a patient no access for an EGD, an attending said go ahead with a central line for the time of EGD (high risk patient). Internal medicine flipped out. I'm a first year resident, I always thought that prolonged central access increased infection but the case has made me question my assumptions. What's the difference between 2 18G in the antecubital v. central for short term? By central I mean IJ, I can see why femoral are more high risk. Thanks for any help by those more knowledgeable!


    Full Member
    7+ Year Member
    Mar 15, 2011
    southern comfort
    1. Attending Physician
      Wtf cares. I've put lines in pts just so they can get a ct chest to rule out the PE I am pretty sure they dont have. If a pt needs access for one reason or the other and you cannot obtain peripheral access despite multiple try's by experienced personnel, which on a floor pt includes an US guided attempt by me, put a line in them. A conventional answer is a picc. But unless your expecting a need for long term access, I wouldn't subject them to the higher risk for DVT picc. Just throw an IJ in and dc it as soon as you can. This is of course in a pt who really needs that access. If you can't sedate them otherwise for a procedure they need and you really can't get peripheral access, do it. We have a lot of sick fatty bad diabetic ESRD pts who you can't get an 18 in for a CTA and we don't do v/q's at night. They get a line.

      I know your question was about infection risk. But my answer is its irrelevant in the scenario you provided.


      SDN Donor
      15+ Year Member
      Dec 30, 2002
      Ann Arbor
      1. Attending Physician
        OP -

        Regarding infection and CVC, I think most agree that IJ and subclav vein are both less infection risk than femoral, and most important is probably getting the central access out as soon as possible.

        I second Boston's mention of taking a look for a peripheral IV yourself. In both of the health systems I've worked in, the IV team was forbidden to place IVs in the lower ext or in the EJ, so things would unfold as follows: beside RN: "I can't get an IV, so I called IV team", then IV team says "...I even tried my favorite special vein, and couldn't even get a 22". And you, as the intern, are too slammed to go check things on your own. But if you have minute, put the pt in T-berg and see if an EJ pops up, or if you can see the EJ on US. Or, throw a tourniquet on mid-calf level, and let the pt's leg hang off the bed, then look at the medial ankle with or without US for a saphenous vein.
        About the Ads
        This thread is more than 7 years old.

        Your message may be considered spam for the following reasons:

        1. Your new thread title is very short, and likely is unhelpful.
        2. Your reply is very short and likely does not add anything to the thread.
        3. Your reply is very long and likely does not add anything to the thread.
        4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
        5. Your message is mostly quotes or spoilers.
        6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
        7. This thread is locked.